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Description of document:
Centers for Disease Control (CDC) Style Guide (2003) and
Correspondence Manual (2012)
Request date:
20-June-2014
Released date:
June 2014
Posted date:
14-July-2014
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CDC Style Guide
August 2003
DC Style Guide
Augut 2003
CDC Style Guide
August 2003
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
1600 Clifton Road, N.E.
Atlanta, Georgia 30333
Send your comments to Pascale Krumm, CDC Style Guide editor.
Contents
Introduction
The CDC Style Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Elements of Good Writing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Section I Grammar and Style
Chapter 1
Common Grammar and Style Difficulties
Chapter 2
Mechanics
5
Active Voice and Passive Voice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Dangling, Misplaced, and Squinting Modifiers . . . . . . . . . . . . . . . . . . . . . 6
Each and Every . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Expletives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Imperative Mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Parallelism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Possessive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Preposition at End of Sentence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Pronouns and Antecedents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Redundancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Sentence Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Subject and Verb Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Singular and Plural of Non-English Words . . . . . . . . . . . . . . . . . . . . . . . 13
Split Infinitives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
That/Which/Who . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Who/Whom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Wordiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Capitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type Styles (Bold, Italics, Underline, and All Caps) . . . . . . . . . . . . . . . . .
17
17
21
23
28
i
Contents
Chapter 3
Numbers
Spelling Out Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Using Numerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Forms of Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Formatting and Style Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chapter 4
Punctuation
Apostrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Brackets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Colons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Commas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ellipses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hyphens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Parentheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quotation Marks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Semicolons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chapter 5
31
31
33
34
35
37
37
38
38
39
42
43
43
46
46
46
47
Words
49
Inclusive Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Word Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Vocabulary Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Section II Visual Media
ii
Chapter 6
Tables, Charts, and Graphs
Chapter 7
Guidelines for Exhibits, Posters, and Electronic Presentations
Chapter 8
Writing for the Web
81
Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Charts and Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
91
Creating Successful PowerPoint Presentations . . . . . . . . . . . . . . . . . . . . 93
Poster Preparation Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
97
Help From the Web . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Contents
Section III Content and Documentation Resources
Chapter 9
CDC-Specific Guidelines
103
Attribution to CDC, CIOs, and HHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Clearance Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Executive Secretariat Correspondence Guidelines . . . . . . . . . . . . . . . . . 110
Chapter 10 Reference Style
Journal Article . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Book and Other Monograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Published Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Legal Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electronic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unpublished Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
121
122
123
124
124
125
126
127
127
Section IV Appendix and Sources
Appendix A–Sample Correspondence
In-house Summary Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary Statement–Secretarial Correspondence . . . . . . . . . . . . . . . .
Secretarial Correspondence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Simple Action Memorandum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Complex Action Memorandum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Briefing Memorandum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Information Memorandum–Sample 1 . . . . . . . . . . . . . . . . . . . . . . . . .
Information Memorandum–Sample 2 . . . . . . . . . . . . . . . . . . . . . . . . .
Information Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Information Advisory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
129
129
130
131
132
134
136
141
143
147
148
Bibliography
149
Index
153
iii
Introduction
“
Of all the arts in
which the wise excel,
Nature’s chief master-
The written word is one of the most effective ways to express thoughts and
ideas, provide and share information, and educate and inform audiences.
A clear and compelling message is based on simple, understandable words,
correct sentence construction, and elegant style.
The CDC Style Guide
The CDC Style Guide will help everyone who writes documents ranging from
letters to press releases to journal articles. The style guide includes writing
guidelines and tips and is designed to save editors and writers time by answering
frequently asked questions about grammar, style, punctuation, preferred word
usage, and reference styles. In addition, the style guide provides guidelines for
producing posters and electronic presentations and for writing for the Web.
Finally, the style guide addresses clearance and correspondence procedures,
presents reference citation styles, and includes useful appendices.
piece is writing well.
”
John Sheffield
All CDC materials need to be clear and accurate. In addition, these documents
should have a uniform look and feel and should reflect and support the CDC
identity. Writers tend to develop a personal writing style, usually a mix of
commonly accepted grammar rules and preferred stylistic conventions. The
CDC Style Guide is meant to be a reference tool, so that everyone at CDC can
have a common place to learn about grammatical questions, and make sure
that our stylistic choices meet accepted rules. The grammar points in this style
guide have been pulled from commonly accepted grammar references such as
the AMA Manual of Style, the Chicago Manual of Style, and Elements
of Style by Strunk and White.
The CDC Style Guide and its companion, the CDC Identity Guide, will help you
communicate with greater efficiency and clarity. These guides will help ensure
that your message is accurate and understandable and that it reflects the agency’s
look and mission. For help with incorporating the CDC identity themes into your
documents, consult the CDC Identity Guide, or the CDC Identity Management
System available at http://intra-apps.cdc.gov/cdcidentity/Login/Home/login.asp.
1
Introduction
The Elements of Good Writing
The following are points to consider when writing your documents.
Be Concise
William Strunk, Jr. captured the essence of good writing when he said, “Vigorous
writing is concise. A sentence should contain no unnecessary words, a paragraph no
unnecessary sentences, for the same reason that a drawing should have no unnecessary
lines and a machine no unnecessary parts.”
Be Clear
Good writing is also clear writing; it should include simple words whenever possible.
Perhaps the one mistake that writers make most often is using complicated words
instead of plain ones. If you want your message to be easily understood, choose simple
words. For further guidance on plain writing, consult CDC’s Scientific and Technical
Information Simply Put at www.cdc.gov/od/oc/simpput.pdf or the Plain English
Network’s (PEN) Web site at www.plainlanguage.gov.
Consider the examples of famous scientists who were concise and used simple language
to convey sophisticated concepts, proving also that simple does not mean simplistic.
Watson and Crick described the double helix (the molecular structure of nucleic acids)
in 900 words, one table, and six references. Arthur Kornberg wrote about the enzymatic
synthesis of DNA in 430 words. Fritz A. Lipmann described coenzyme A in 250 words,
one table, and five references.*
Be Precise
Good writing is also precise. The accurate and precise use of words is crucial in the
medical and scientific fields. Your words can leave no room for error or
misinterpretation. Many words in the English language are similar in meaning or
sound. Be sure to know the differences between these words so you use the right word
every time.
Be Correct
Finally, good writing is error-free and grammatically and stylistically correct. Incorrect
grammar, confusing punctuation, erratic spelling, and awkward sentence construction
* Adapted from Martin M. Cummings, M.D., former director of the National Library of Medicine, in his 1973 honor lecture to the American Medical Writers Association.
2
Introduction
will impede your message, slow the reading process, and make your writing
Tip: For Your Writing
look careless and unprofessional. A well-written
document ensures that your message gets through.
As you write, ask yourself the following questions:
■ What is my key message?
■ Am I accurately conveying my message?
■ Will the readers immediately understand my message?
■ Can I summarize my point in a few short and precise sentences?
■ Can I express myself more clearly?
■ Did I use the right words?
Tip: Writer’s Checklist
These tips are adapted from the Elements of Style by Strunk and White and are further developed in this
style guide.
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
Write for your audience (identify your audience and its interests, education level, and other specifics).
Use simple words (we used, NOT we utilized).
Omit unnecessary words (near, NOT in the vicinity of).
Avoid expletives (there is, there are).
Avoid redundancies (blue, NOT the color blue).
Avoid gender-specific words (firefighter, NOT fireman).
Avoid jargon, archaic words, and buzz words (aspect, idea, absolutely, really).
Avoid nominalization. Use verbs, not nouns (the plan describes, NOT contains a description of).
Use strong action verbs (consider, NOT give consideration to; concerns, NOT is concerned with).
Be brief and concise. Use short sentences and paragraphs. A readable sentence is short, simple, affirmative, and declarative.
Use active rather than passive voice whenever possible (I will know, NOT it will be known).
Avoid using too many capitals.
Avoid negatives (unsafe instead of not safe).
Avoid split infinitives whenever possible (to go boldly, NOT to boldly go).
Be consistent in word use (if you call it a widget the first time, call it a widget throughout).
Use parallel construction (in sentences, in lists).
Use bullets for lists.
Use tables, graphs, and charts, if appropriate.
Use good design and layout, with plenty of white space (too many words on a page discourage readers before they begin reading).
Use informative, meaningful titles, headings, and subheadings.
3
1 Common Grammar and Style Difficulties
“
Grammar is the prism
through which all
writing is refracted.
Writing clearly, concisely, and professionally requires the use of correct
grammar. Nothing jars the reader more than coming upon words that are used
incorrectly, subjects and verbs that do not agree, or misplaced modifiers that
muddle the meaning of a sentence. This chapter discusses, in alphabetical
order, the grammar rules and style principles you will encounter most
frequently. Many topics mentioned in this section are discussed in depth in
other sections of the CDC Style Guide.
”
Patricia Robertson
Active Voice and Passive Voice
A verb is in the active voice when the performer of the act is the subject of the
sentence. A verb is in the passive voice when the performer of the act is the
object of the sentence.
Active voice: The physician examines the patient.
Passive voice: The patient is examined by the physician.
As a rule, use the active voice because it is more accurate, direct, precise, and
interesting. Active voice is shorter and easier to read; it also flows better. The
passive voice traditionally was the norm in technical writing because it was
considered to be more scientific or objective. Most journals now encourage
the use of the active voice.
However, the passive voice is preferred in the following circumstances, when:
■ The subject is unknown.
Example: A memo was circulated in the office.
■ The subject is irrelevant to the matter or obvious.
Example: The samples are being analyzed.
■ The emphasis needs to be on the object, not the subject.
Example: Smallpox was eradicated in 1980.
5
GRAMMAR AND STYLE
Dangling, Misplaced, and Squinting Modifiers
A modifier is a word or phrase that describes another word or phrase in the sentence.
A modifier should be placed close to the word or group of words it modifies.
Dangling Modifier
A dangling modifier occurs when a word or phrase is implied rather than stated in a
sentence. Adding the proper word or rephrasing the sentence can correct the mistake.
Incorrect:
Having compiled all the data by hand, his results were illegible.
Correct:
Because he had compiled all the data by hand, his results were illegible.
Misplaced Modifier
Misplaced words or phrases can result in ambiguous, humorous, or absurd statements.
Incorrect:
She went into the hospital after being bitten by a spider in a bathing suit.
Correct:
She went into the hospital in a bathing suit after being bitten by a spider.
Incorrect:
Correct:
The patient was referred to a psychiatrist with severe emotional problems.
The patient with severe emotional problems was referred to a psychiatrist.
Squinting Modifier
The imprecise placement of a modifier yields a squinting modifier. Be careful with
modifiers such as almost, exactly, even, hardly, just, merely, nearly, only, scarcely, and
simply. Their placement may alter the meaning of the sentence. Place the modifier to
produce the meaning you intend to produce.
Examples: They were only asking about the vaccine. (As if it were a minor issue)
They were asking only about the vaccine. (They asked about nothing else.)
Only they were asking about the vaccine. (No one else asked.)
Each and Every
Each and every are always singular, whether they are used as indefinite pronouns or as
modifiers.
Examples: Each of us has a task to complete.
Every epidemiologist, physician, and health official is dedicated to making
this country safe and healthy.
6
Common Grammar and Style Difficulties
Expletives
Expletives are not just four-letter words. The words There or it followed by a form of to
be also are called expletives. Starting a sentence with an expletive often results in
unnecessary verbiage. To be clear and concise, avoid expletives.
Avoid:
There is evidence to suggest that smoking causes stomach cancer.
Use:
Evidence suggests that smoking causes stomach cancer.
Avoid:
Use :
It is often difficult to find links between diseases and the environment.
Finding links between diseases and the environment is often difficult.
Imperative Mood
To emphasize recommendations and suggestions, use the imperative mood.
Weak:
It is recommended that a committee be formed to study the cause of
the fire.
Better:
Form a committee to study the cause of the fire.
Parallelism
In parallel constructions, nouns must be parallel with nouns, verbs with verbs,
adjectives with adjectives, and so on. Faulty parallelism is common and results in
muddled communication.
Not parallel: Leave your name, number, and a brief message.
Parallel:
Leave your name, your number, and a brief message.
Parallel:
Leave your name, number, and message.
Not parallel: The scientist’s goals were to find a cure and developing a vaccine.
Parallel:
The scientist’s goals were to find a cure and to develop a vaccine.
Parallel:
The scientist’s goals were finding a cure and developing a vaccine.
Not parallel: The proposed design is inefficient, invalid, and a danger to people’s health.
Parallel:
The proposed design is inefficient, invalid, and dangerous to
people’s health.
7
GRAMMAR AND STYLE
Correlative pronouns (both . . . and, either . . . or, neither . . . nor, not only . . . but also,
whether . . . or) also must be parallel. For example, if a preposition applies to both
elements, either place it before the first correlative or include it in both elements.
Not parallel: He was critical neither of the study design nor the results.
Parallel:
He was critical neither of the study design nor of the results.
Parallel:
He was critical of neither the study design nor the results.
Bulleted lists also must be parallel. The first item in each bullet must be in the same
grammatical category.
Not parallel: A healthy lifestyle includes the following:
■ Eating right.
■ Avoidance of sweets.
■ Exercise daily.
■ Getting enough rest.
Parallel:
A healthy lifestyle includes the following:
■ Eating right.
■ Avoiding sweets.
■ Exercising daily.
■ Getting enough rest.
Passive Voice
See “Active Voice and Passive Voice” on page 5.
Possessive
General Rule
The possessive of most singular nouns is formed by adding an apostrophe and an s (’s).
The possessive of most plural nouns (except for a few irregular plurals) is formed by
adding an apostrophe only.
Examples: the center’s director
the laboratories’ conclusions
the children’s health
8
Common Grammar and Style Difficulties
Singular Noun
For a singular noun, add ’s, even if the noun already ends with an s.
Examples: the researcher’s conclusion
the fox’s fur
the virus’s origin
Plural Noun
For a plural noun ending with an s, add an apostrophe only; do NOT add an
extra s.
Examples: the researchers’ conclusions
the foxes’ fur
the viruses’ origins
For a plural noun not ending with an s, add ’s only.
Examples: women’s health
the data’s accuracy
five sheep’s wool
Nouns Ending and Starting With an S Sound
If the first noun ends with an s (or an s sound) and the second noun starts
with one, rephrase the sentence to avoid awkward pronunciation.
Awkward: the Congress’s situation
Use:
the situation of Congress
Awkward:
Use:
the analysis’s significance
the significance of the analysis
However, if the final s (or x or z) of the first word is silent, insert ’s to yield the
proper pronunciation.
Examples: Lemieux’s science
Arkansas’s situation
Descartes’s theories
Special Case–Eponyms
Eponyms, which are nouns derived from proper names of people, are common
in scientific literature (Hansen’s disease, Pascal’s triangle). Although the
possessive has been used traditionally in eponyms, the trend is to eliminate it.
For example, the National Down Syndrome Society spells the condition
without the apostrophe.
9
GRAMMAR AND STYLE
Following is a list of terms commonly used, with their preferred spellings.
Alzheimer disease
Crohn disease
Down syndrome
Graves disease
Hodgkin disease
Parkinson disease
Reye syndrome
Wilms tumor
If the term includes more than one person, do not use the apostrophe.
Incorrect:
Creutzfeldt-Jacob’s disease
Correct:
Creutzfeldt-Jacob disease
Note:
Achilles’ heel BUT Achilles tendon
The following table summarizes the rules of the possessive.
Noun
Rule
Singular Noun
Add ’s.
the pill’s effectiveness
Plural Noun
Two Nouns
the box’s location
the lens’s cost
For nouns ending with s or es, add apostrophe only.
the pills’ effectiveness
the boxes’ location
the lenses’ cost
For nouns not ending with s, add ’s.
men’s cancer rates
the bacteria’s origins
deer’s ticks
If the first noun ends with an s (or s sound) and the second noun starts with
one, rephrase the sentence.
the strength of the analysis (NOT the analysis’s strength)
If the first noun ends with a silent s, x, or z, add ’s to yield the
proper pronunciation.
Descartes’s century
Lemieux’s lectures
Eponym
10
The tendency is to move away from using the possessive.
Weber law (NOT Weber’s law)
Common Grammar and Style Difficulties
Preposition at End of Sentence
You may be familiar with a rule that says not to end a sentence with a
preposition. When confronted with the rule, Winston Churchill said, “This is
the sort of pedantry up with which I will not put.” Although you should not
abuse the practice, ending a sentence with a preposition can be appropriate.
Example:
CDC provides health information people can count on.
Pronouns and Antecedents
You can shorten sentences by using pronouns, but be sure they have clear
antecedents. For example, in the preceding sentence the antecedent of the
pronoun they is unclear. Does it refer to sentences or to pronouns? Sometimes
you have to rephrase the sentence or repeat the word.
Correct:
You can shorten sentences by using pronouns, but be sure the
pronouns have clear antecedents.
Punctuation
See the “Punctuation” chapter on page 37.
Redundancy
Redundancy is the use of several words that mean the same thing when one
word would suffice. Redundancies make your writing seem careless and sloppy.
Some redundancies are so common that you may be unaware of them, such as
reverting back (you can only revert back) or general consensus (there is no other
type of consensus). However, once you are aware of the problem, it is easy to
correct. For a list of common redundancies, see the “Tautologies and
Redundancies” section on page 77.
11
GRAMMAR AND STYLE
Sentence Length
Try to vary the length of your sentences; this will help delineate your ideas and
maintain your readers’ interest. Sentences that are all the same length are
monotonous; sentences that are too short produce a choppy effect; and
sentences that are too long are difficult to follow.
Sentence length also affects the readability of your material, which is something to consider if you are writing at a specific reading level. To assess the
readability of a document, use the SMOG readability formula, which can be
accessed at www.cdc.gov/od/ads/smog.htm.
Subject and Verb Agreement
Sometimes it is difficult to decide whether a verb should be singular or plural.
The following list provides some guidance.
The number of, the total number of: the verb is singular.
Examples:
The number of samples was unknown.
The total number of cases was hard to predict.
A number of, a total of: the verb is plural.
Examples:
A number of patients were examined.
A total of 50 vials were sent to the laboratory.
As well as, in addition to, along with: the verb agrees with the main subject only.
Example:
Rubella, as well as chickenpox, is contagious.
Or, neither . . . nor, either . . . or: the verb agrees with the subject closest
to the verb.
Examples:
The physicians or the nurse has to be present.
The physician or the nurses have to be present.
Neither the medication nor the hospital stays were helpful.
Neither the hospital stays nor the medication was helpful.
None, other quantities: the agreement of the verb is context dependent.
None:
12
None of the medication was taken.
None of the symptoms were present.
Common Grammar and Style Difficulties
Quantities: Half of the pill was enough.
Half of the patients were sent home.
Singular and Plural of Non-English Words
Many scientific terms are derived from other languages, particularly Latin and Greek.
The plural forms of non-English terms often follow the rules of the original language.
Following is a sample list of such terms. Because usage varies by publication, some
terms have alternate plural spelling. For a more complete list, see the “Plural Endings
from Non-English Languages” section of the CBE Manual for Authors, Editors, and
Publishers (6th edition, page 88).
Singular
Preferred Plural
Acceptable Plural
alga
appendix
criterion
datum
femur
genus
index
insignia
phenomenon
thorax
medium
vertebra
algae
appendices
criteria
data
femora
genera
indexes
insignia
phenomena
thoraxes
media
vertebrae
…
appendixes
criterions
…
femurs
…
indices (in economics and mathematics)
insignias
…
thoraces
mediums
vertebras
Split Infinitives
In general, avoid awkward constructions that split infinitive forms of a verb (to leave,
to help) or compound forms (had left, are found out).
Avoid:
She was ordered to immediately leave on an assignment.
Use:
She was ordered to leave immediately on an assignment.
However, there are occasions when a split infinitive is necessary to convey meaning.
Examples: He wanted to really help his mother.
13
GRAMMAR AND STYLE
That/Which/Who
These pronouns are not interchangeable.
That and which refer to animals, things, or anonymous groups of people. Use
that to introduce a restrictive (defining, limiting) phrase and which to introduce a
nonrestrictive (parenthetical, nondefining) phrase. Insert commas before and after
nonrestrictive phrases.
Hint: If the clause being introduced by that or which could be omitted or put in
parentheses, use which. Otherwise, use that.
Who refers to people and animals with names or special talents. Who can introduce
restrictive and nonrestrictive clauses.
That:
The samples that he analyzed had been stored for 2 weeks. (The clause
that he analyzed defines the noun samples; it tells which samples had been
analyzed.)
Which:
The samples, which he analyzed, had been stored for 2 weeks. (Which
introduces extra information that could be dropped without affecting the
sentence.)
Who:
The giant pandas Lun Lun and Yang Yang, who came to Atlanta in 1999,
attract a lot of visitors.
Tip: Who or Whom?
Correctly Choosing Who or Whom
1. Locate the main clause (in bold here).
a. He is the one [who/whom] found a cure.
b. He is the one [who/whom] everyone admires.
2. Drop who or whom from the main clause, you are left with a gap.
a. __________ found a cure.
b. everyone admires ___________.
3. If he makes sense in the gap, who is correct; if him makes sense, whom is correct.
a. he found a cure makes sense; therefore, the correct word is who.
b. everyone admires him makes sense; therefore, the correct word is whom.
14
Who/Whom
The distinction between who and whom is often
lost. However, these pronouns are not interchangeable; who stands for the subject of a clause,
whereas whom replaces the object of a sentence.
Who:
Marie Curie is a scientist who won two
Nobel prizes. (Who stands for Marie
Curie, the subject of the sentence.)
Whom: Marie Curie is a scientist whom we all
heard about. (Whom replaces scientist,
the object of the sentence.)
Common Grammar and Style Difficulties
Wordiness
Effective writing is concise and to the point. As W. Somerset Maugham said, “Stick to
the point, and, whenever you can, cut.” Use the minimum number of words for the
maximum effect. One key is to use strong verbs in the active voice and to limit the use
of nouns, adverbs, adjectives, and buzz words. See the “Jargon”section on page 73 for
examples of wordiness and their alternatives.
Weak:
It is very important for all necessary precautions to be followed
scrupulously.
Better:
Follow all precautions.
Weak:
Better:
A considerable number of people are utilizing the test at the present
time.
Many people are using the test now.
15
“”
Tis better to be brief
2 Mechanics
than tedious.
Shakespeare
This chapter covers the use of abbreviations, acronyms, capital letters, and type
styles. Although some rules are set, others are more flexible and depend on
convention. For example, some manuals advocate the use of the article the in
front of an acronym, others do not.
The rules mentioned in this section reflect long-standing CDC usage (we say
CDC and not the CDC). However, as usual, the most important rule is to be
consistent throughout the document and to use common sense over dogma.
Abbreviations
To ensure proper comprehension follow these rules: use abbreviations sparingly
in text, never start a sentence with an abbreviation, and insert a period after
most abbreviations. Following are examples of the correct use of abbreviations.
Addresses and U.S. States
In Letter Writing
On envelopes or in letters you can either abbreviate or spell out addresses.
However, always abbreviate directions (N.E.). To abbreviate states, use the
two-letter postal code (GA, MT).
Note: The policy of the Office of the Executive Secretariat is NOT to use abbreviations with addresses, neither on the envelope nor in the body of the letter, except
for directions.
Non-abbreviated Example
Centers for Disease Control and
Prevention
1600 Clifton Road, N.E., Mailstop D-14
Atlanta, Georgia 30333
Abbreviated Example
Centers for Disease Control and
Prevention
1600 Clifton Rd., N.E., MS D-14
Atlanta, GA 30333
17
GRAMMAR AND STYLE
In Text
In text, spell out names of U.S. states when they stand alone or are used after a county.
When a city and state are inside a sentence, place commas after the city and the state.
Spell out the name of the state after the city or use standard abbreviations (see the
list of abbreviations on page 19). Use the two-letter postal code (GA, MT) with ZIP
codes only.
Examples: They live in Fulton County, Georgia, but near the DeKalb line. (NOT
Fulton County, GA)
The agency is headquartered in Atlanta, Georgia, and has 10 regional
offices.
The agency is headquartered in Atlanta, Ga., and has 10 regional offices.
(NOT GA)
Use the abbreviation U.S. only as an adjective; spell out United States when it is used as
a noun.
Examples: The latest U.S. figures show that one out of every four deaths results from
cancer.
In the United States, one out of every four deaths results from cancer.
Include the name of the state at the first mention of the city if the clarification is
important. Do not include the name of the state if it would be redundant. Do not
include the city if it is irrelevant.
Examples: The chemical leak occurred in Paris, Texas. (Several cities share that name.)
She studied at the University of Virginia in Charlottesville. (Adding
Virginia after the city is redundant.)
The Centers for Disease Control and Prevention released new guidelines.
(Atlanta is irrelevant.)
18
Mechanics
Following is a list of standard and postal abbreviations for U.S. states, including freely
associated states. State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of
Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Abbreviation
Ala.
Alaska
Amer. Samoa
Ariz.
Ark.
Calif.
Colo.
Conn.
Del.
D.C.
Postal Code
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
F.M.
Fla.
Ga.
Guam
Hawaii
Idaho
Ill.
Ind.
Iowa
Kans.
Ky.
La.
Maine
M.H.
Md.
Mass.
Mich.
Minn.
Miss.
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
State
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Abbreviation
Mo.
Mont.
Nebr.
Nev.
N.H.
N.J.
N.M.
N.Y.
N.C.
N.Dak.
M.P.
Ohio
Okla.
Ore.
P.W.
Pa. or Penna.
P.R.
R.I.
S.C.
S. Dak.
Tenn.
Tex.
Utah
Vt.
Va.
V.I.
Wash.
W. Va.
Wis.
Wyo.
Postal Code
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
19
GRAMMAR AND STYLE
Formal Titles and Academic Degrees
Abbreviate formal titles (e.g., Dr., Mr., Mrs., Ms.) in front of a last name. However, spell
out Doctor and Professor if they start a sentence or if they do not immediately precede a
last name.
Examples:
We met Dr. Archer at the conference.
Doctor Archer attended the conference.
Stephen W. Hawking is the Lucasian Professor of Mathematics at
Cambridge University.
Academic degrees (M.P.H., Ph.D.) are usually abbreviated. Do not include both an
academic degree and Dr. with one name.
Example:
Beverly Crusher, M.D., M.P.H. (NOT Dr. Beverly Crusher, M.D.,
M.P.H.)
Journal Titles
For a scientific audience, abbreviate the names of journals in reference lists according to
the National Library of Medicine’s Index Medicus at www.nlm.nih.gov/tsd/
serials/lji.html. Do not italicize these abbreviations. For more details, see the “Reference
Style” chapter on page 121.
For lay audiences (including Congress) and in texts, spell out and italicize the names of
journals.
Mathematical Symbols
In text, avoid using mathematical symbols; use words instead. For more details on
using mathematical symbols, see the “Numbers” chapter on page 31.
Avoid:
We examined 90+ patients.
Use:
We examined more than 90 patients.
Scientific Terms
The list of abbreviations commonly used in the scientific field (such as units of measure
or technical terms) is too large to be included here. An exhaustive list can be found in
the AMA Manual of Style (9th edition, chapter 11).
20
Mechanics
Acronyms
Acronyms, unlike abbreviations, are not followed by periods.
When to Use Acronyms
Spell out the term on first reference, followed by its acronym in parentheses. Use the
acronym in the rest of the document.
Example:
The Centers for Disease Control and Prevention (CDC) is testing the
samples. According to CDC, the result should be available in 48 hours.
If the expanded form includes a possessive, do not include the possessive in the
parentheses.
Example:
The Centers for Disease Control and Prevention’s (CDC) guidelines are
listed on the Internet.
When to Use the With Acronyms
Omit the article the when the acronym is pronounced as a word (e.g., OSHA, NIOSH). If
the acronym is not pronounced as a word, the rule depends on usage. The preferred usage
at CDC is to omit the article in front of most acronyms unless it looks or sounds odd.
Incorrect:
The NIOSH conducts research on occupational diseases and injuries.
Correct:
NIOSH conducts research on occupational diseases and injuries.
Acceptable:
Preferred:
At the CDC, we work hard to make people safer and healthier.
At CDC, we work hard to make people safer and healthier.
When NOT to Use Acronyms
If a term appears only once or a couple of times in the document, spell it out rather
than use the acronym. Remember that the use of many acronyms in a single document
can impede comprehension and result in an “alphabet soup.”
Some terms such as HIV or AIDS are so familiar that they do not need to be spelled out.
Avoid acronyms at the beginning of a sentence, in a title, or a heading, unless the
acronym spells out a word (AIDS) or stands for an agency.
Avoid:
Council for Scientific Research (CSR)
Use:
Council for Scientific Research
21
GRAMMAR AND STYLE
Acronyms for CDC Centers, Institute, and Offices
The following table gives an overview of CDC’s organizational components, as of
August 2003.
National Center on Birth Defects and (NCBDDD)
Developmental Disabilities
National Center for Chronic Disease
Prevention and Health Promotion
(NCCDPHP) prevents premature death and disability from chronic
diseases and promotes healthy personal behaviors
National Center for
Environmental Health
(NCEH)
provides national leadership in preventing and
controlling disease and death resulting from
interactions between people and their environment
National Center for Health Statistics
(NCHS)
provides statistical information that will guide actions and
policies to improve the health of the American people
National Center for HIV, STD,
and TB Prevention
(NCHSTP)
provides national leadership in preventing and
controlling human immunodeficiency virus infection,
sexually transmitted diseases, and tuberculosis
National Center for
Infectious Diseases
(NCID)
prevents illness, disability, and death caused by infectious diseases in the United States and around the world
National Center for Injury
Prevention and Control
(NCIPC)
prevents death and disability from nonoccupational
injuries, including those that are unintentional and
those that result from violence
National Immunization Program
(NIP)
prevents disease, disability, and death from vaccinepreventable diseases in children and adults
National Institute for Occupational
Safety and Health
(NIOSH)
ensures safety and health for all people in the workplace through research and prevention
Epidemiology Program Office
(EPO)
strengthens the public health system by coordinating
public health surveillance; providing support in
scientific communications, statistics, and epidemiology;
and training in surveillance, epidemiology, and
prevention effectiveness
Public Health Practice Program Office (PHPPO)
22
provides national leadership for preventing birth defects
and developmental disabilities and for improving the
health and wellness of people with disabilities
strengthens community practice of public health by
creating an effective workforce, building information
networks, conducting practice research, and ensuring
laboratory quality
Mechanics
Capitalization
Capitalizations within sentences should be used sparingly and accurately. In general,
avoid unnecessary capitals because they slow the reading process. Use a capital letter
only if you can justify it by one of the principles listed below.
Bulleted Lists
Capitalize the first word of each bulleted item.
Example:
Take the following precautions to protect yourself from UV exposure:
■ Limit direct sun exposure during midday.
■ Cover up.
■ Wear a hat.
■ Use a sunscreen with an SPF of 15 or higher.
Compass Points
Capitalize north, south, east, and west when they designate regions but not when they
designate directions.
Examples: Chicago is in the Midwest, but Atlanta is in the Southeast.
Acupuncture comes from the Far East.
Amicalola Falls State Park is in North Georgia.
The airport is 10 miles southwest of town.
Cross-references in Text
Capitalize nouns (e.g., table, figure, chapter, volume, appendix) if they are used as
designators in the text and followed by a number or letter.
Examples: As described in Table 2
The cancer cells were spreading (Figure A)
Consult Volumes 2–4
See Chapter 5, Section B
When referring in general terms to a section or chapter do not capitalize these words.
However, when referring specifically to the title of a section or chapter, capitalize the
title as it appears originally and enclose it in quotation marks.
23
GRAMMAR AND STYLE
Examples:
See the chapter on genetics. (chapter is set in lowercase because it is a
designator and not a title.)
See Chapter 2 on genetics. (Chapter is capitalized because a number
follows it.)
See the “Genetics” chapter. (Genetics is capitalized and in quotation marks
because it is the title of that chapter.)
See the next chapter, “Punctuation,” for more. (Note the commas.)
Set the words line and page in lowercase.
Example:
The section starts on page 25, line 12.
Diseases and Microorganisms
When an eponym is included in the name of the disease, syndrome, or other term, do
not capitalize the second word.
Parkinson disease
Down syndrome
Do not capitalize eponyms referring to units of measure or other well-established
common usage terms. Do not capitalize eponyms derived from proper nouns (and
used as adjectives).
curie
joule
caesarean delivery
fallopian tube
addisonian crisis
parkinsonian tremor
For microorganisms, except viruses, capitalize the singular genus name but not the
specific epithet, and italicize both. Do not capitalize or italicize the genus name in the
plural. Do not capitalize or italicize the name of viruses.
Examples: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis.
The genus Ehrlichia includes seven recognized species. (Singular)
A number of other ehrlichiae also cause diseases in animals. (Plural)
The hepatitis B virus attacks the liver.
First Word of a Quotation
Quoted material should respect the original form. Usually the first word of a quote is
capitalized. However, if the quotation is integrated into the sentence, you may want to
use lowercase.
Examples: The article noted, “More than 2 million screening tests were provided.”
The article noted that “more than 2 million screening tests were provided.”
24
Mechanics
Geographic Names
Capitalize all geographic locations, including cities, counties, states, regions,
countries, continents, bodies of water, mountains, forests, canyons, dams,
parks, and streets. Following are some examples.
the Antarctic
the Atlantic Ocean
the Bay Area
Central Africa
the Great Lakes
the Gulf of Mexico
the Hoover Dam
Hudson Bay
Lake Ontario
Mexico City
the Mississippi River
New York State
the South Pole
Yellowstone National Park
the West Coast
Although a common noun (sea, ocean, park, river) used with a geographic
name is capitalized in the singular, it is not capitalized in the plural.
Examples: the Mississippi River
the Mississippi and Missouri rivers
Government Agencies, Businesses, and Other Institutions
Capitalize the names of government agencies, businesses, and other
institutions. Do not capitalize conjunctions, articles, or prepositions of three or
fewer letters unless they start a sentence.
Congress
the U.S. government
the U.S. Army
the International Committee of the Red Cross (NOT Of The Red Cross)
For names of institutions, do not capitalize the article the unless it is part of the
official title.
Examples: He gave a speech at The Johns Hopkins University.
He gave a speech at the University of Virginia.
When the name of the institution is used as a common noun, do not capitalize it.
Example:
In 1990, she graduated from the University of Virginia. After she
left the university, she moved to Atlanta.
Note: Do not capitalize federal, state and local, unless they start the sentence.
Example:
The task force advises federal, state, and local governments.
Proprietary Names
Capitalize proprietary names of drugs and products, but do not include the
trademark symbol. Do not capitalize the generic names of drugs.
Example:
The physician prescribed Tylenol (acetaminophen).
25
GRAMMAR AND STYLE
Seasons and Holidays
Capitalize holidays and calendar events, but do not capitalize seasons.
Labor Day
Fourth of July
summer
fall
Sociocultural Derivatives
Capitalize names of languages, peoples, races, ethnic groups, nationalities, political
parties, and religions. However, do not capitalize white or black when referring to race.
the English language
French people
African Americans (BUT blacks)
Democrats and Republicans
Buddhist monks
Titles of Books, Essays, Headings, and Conferences
Capitalize major words and two-letter verbs (do, go, be). Do not capitalize the to of the
infinitive, conjunctions, articles, or prepositions of three or fewer letters, unless they
begin a sentence. Italicize titles if they are in running text.
Examples: What Is Rheumatoid Arthritis? (A stand-alone title is not italicized.)
How to Treat Ear Infections in Small Children
Call the toll-free number to order What Is Rheumatoid Arthritis? (A title
inside a sentence is italicized.)
Capitalize both parts of dual verbs.
Examples: Gearing Up for a Healthier Lifestyle
Following Up on the Anthrax Scare
Do not capitalize the second part of hyphenated words.
Examples: Follow-up on the AIDS Vaccine
Long-term Effects of Radiation Exposure
Titles of Persons
Capitalize only formal titles used directly before a person’s name.
Examples: In 1933, President Roosevelt said,“The only thing we have to fear is fear itself.”
The president said, “The only thing we have to fear is fear itself.”
In general, do not capitalize long titles; separate them from the individual’s name with
a comma.
Example:
William Riker, the undersecretary of the cabinet, was the guest speaker.
26
Mechanics
The following table summarizes the use of capitals and lowercase letters. Capital Letter
Bulleted Lists
Compass Points
Cross-references in Text
Diseases and Microorganisms
First Word of a Quotation
Geographic Names
Government Agencies, Businesses,
and Other Institutions
Proprietary Names
Seasons and Holidays
Sociocultural Derivatives
Titles of Books, Essays,
Headings, and Conferences
Titles of Persons
Take these precautions:
■ Limit direct sun exposure.
■ Cover up.
■ Wear a hat.
the South (a region)
Table 2, Chapter 5
see Chapter 5 on numbers
see the “Numbers” chapter
Parkinson disease
E. coli
He said, “We are ready.”
Atlantic Ocean
Congress
the U.S. government
the Republican Party
the Iowa State Supreme Court
the University of Virginia
Amoxyl (brand name)
Memorial Day
Native American, Hispanic
A Brief History of Time
President Roosevelt
Lowercase Letter
turn south (a direction)
this table, this chapter
see the chapter on numbers
go to page 10, line 2
parkinsonian gait
coliform bacteria group
He said that “we are ready.”
the ocean
congressional
the government
the party
the state supreme court
the university
amoxicillin (generic name)
spring, winter
black, white
The Long-term Benefits of Exercise
(Do not capitalize to of the infinitive,
conjunctions, articles, or prepositions
of three letters or less unless they
start a sentence.)
the president
27
GRAMMAR AND STYLE
Type Styles (Bold, Italics, Underline, and All Caps)
Bold, italics, underline, and ALL CAPS are common features to help you alter the look
of a document. Use these elements sparingly and with caution. If used incorrectly or
too frequently, these features will distract from the flow of the words.
Using Type for Emphasis
To emphasize a point, use bold and italics instead of underlining or ALL CAPITAL
LETTERS. Underlined text is more difficult to read and should be avoided. For the
same reason, DO NOT WRITE EXTENDED AMOUNTS OF TEXT IN ALL CAPS. Use
all caps only for short titles. In the rare instances where you have to use all caps in a
text, use short words and bold them (e.g., DANGER!).
Italics
Italics are used for emphasis and in the following contexts:
Titles
When referencing in a document, italicize titles of books, magazines, newspapers,
journals, pamphlets, films, television and radio programs, software programs, works of
art, ships, and planes. All other titles are enclosed in quotation marks. Note: Do not
italicize titles if they appear in references at the end of a document. For more
information, see the “Reference Style” chapter on page 121.
New York Times
Federal Register
Meet the Press
Excel
USS Enterprise
Picasso’s Guernica
Legal References
In a text, the names of cases, federal regulations, congressional hearings, and laws are
written in the following manner. Note: Do not italicize these if they appear in references
at the end of a document.
Case:
Wilcox v United States, 387 F2d 60 (5th Cir 1967)
Federal Regulation: 66 Federal Register 7068 (2001) (codified at 25 C.F.R. §15)
Hearing:
Field Hearing on Air Quality and Health Impacts of the September
11 Attack on the World Trade Center, 107th Cong., 1st Sess. (2002)
(testimony of U.S. Representative Jerrold Nadler, D-NY)
28
Mechanics
The names of statutes are not italicized.
Example:
Comprehensive Environmental Response, Compensation, and Liability
Act, 42 U.S.C. §9601-9675 (1988)
Non-English Words and Phrases
Many foreign words are now part of the English language and are not italicized.
However, italicize the words and phrases that have not been assimilated.
in vitro
in vivo
versus
tour de force
coup d’état
incommunicado
Scientific Terms
Some scientific terms are italicized for clarification or because they are foreign words.
The rules for italicizing organisms are elaborate; we will mention only the most
common rules. For more details, consult the “Nomenclature” chapter in the AMA
Manual of Style (9th edition).
Italicize names of bacterial organisms, parasites, and strains in the singular. Capitalize
the first word only.
Examples: the common human pathogen Helicobacter pylori
the malaria parasite Plasmodium vivax
Escherichia coli O157:H7 (Use the letter O and not the numeral 0.)
If the names are used in the plural, use lowercase and do not italicize them. If you
cannot determine the plural form, add the word organism or species after the italicized
term.
Example:
typing of group A streptococci
29
3 Numbers
“
I have often admired
the mystical way of
Pythagoras and
Use numbers correctly in written documents to ensure accuracy and to avoid
confusion. Various guidelines govern the use of numbers in text and help
determine whether to use numerals (1, 2, 3, I, II, III) or words (one, two,
three).
the secret magic
of numbers.
”
Sir Thomas Browne
Because the recording of numbers is based more on conventions than on rules,
different sources adhere to different conventions. Therefore, use common
sense, not dogma, when deciding which guidelines to apply. However, using the
following guidelines promotes uniformity for all CDC documents.
For more details on the use of numbers, refer to the AMA Manual of Style.
Spelling Out Numbers
General Rule
In text, spell out numbers one through nine. Use numerals for 10 and above.
Zero is usually spelled out, so as not to be confused with the letter O.
Examples: The virus infected five laboratory workers and seven animals.
The virus infected 10 laboratory workers and 12 animals.
When recording numbers in tables and figures—not in text—always use
numerals. In addition, use numerals for units of measure (e.g., age, time,
money) and forms of numbers (e.g., decimals, percents), even if they are below
10. For more details, see the “Using Numerals” section on page 33.
Examples: He came to the agency 2 years ago.
Toxic shock syndrome is fatal in 5% of cases.
Combination of Numbers Less Than and Greater Than 10
If you have a combination of numbers less than and greater than 10, treat
related numbers alike.
31
GRAMMAR AND STYLE
Example:
In 1997, two outbreaks of Ebola virus hemorrhagic fever resulted in 12
cases and 8 deaths. (Numerals are used for all related items because one of
them is greater than nine. The first number is spelled out because it is
unrelated and less than 10.)
Numbers Beginning a Sentence, Title, or Heading
Spell out the number if it starts a sentence, title, heading, or subheading. When a unit
of measure or a symbol follows the number, it too must be spelled out. It is usually
better to rephrase the sentence.
Correct:
Eighty milligrams of aspirin per day can help prevent the recurrence of a
heart attack.
Better:
Taking 80 mg of aspirin per day can help prevent the recurrence of a heart
attack.
If the number is a year, it can be expressed numerically.
Correct:
1980 marked the eradication of smallpox.
Better:
The year 1980 marked the eradication of smallpox.
Consecutive Numbers
To avoid confusion or ambiguity in the case of two consecutive numbers that cannot
easily be separated, spell out the one that is more easily understood in word form, or
try to rephrase the sentence.
Example 1: The package contains twenty 50-mg pills.
Example 2: Out of five hundred, 200 were affected.
Better:
Out of 500, a total of 200 were affected.
Large and Indefinite Amounts
Spell out indefinite numbers and amounts.
Examples: several hundred investigators
a few thousand people
thousands of people
Common Fractions
Spell out common fractions. Insert a hyphen only if the fraction modifies a noun.
Examples: Patients have adverse reactions to the medication in one third of the cases.
A two-thirds majority is needed. (NOT two-third)
32
Numbers
Using Numerals
General Rule
In scientific text, express units of measure (e.g., age, time, money) and forms of
numbers (e.g., decimals, percents) in numerals, even if they are below 10.
Examples: Preventing a cavity through water fluoridation costs about $4.
Only about 6% of children 4 to 8 years of age ride in booster seats.
Units of Measure
The following table outlines the main units of measure, with examples. Age
Clock Time
Compound Modifier
Date
Measurement Range
Money
at the age of 65 years
five patients 65 years and older
adults over 18 years old
the patient, age 79 years, recovered
the 79-year-old patient
children 5 to 9 years of age
6 p.m.
6 o’clock (NOT 6 o’clock p.m.)
noon (NOT 12 noon)
noon to 1:30 p.m. (NOT 12 noon)
8 a.m. to 5 p.m.
8:00 a.m. to 5:30 p.m. (NOT 8 a.m. to 5:30 p.m.)
a 6-foot-5-inch person
an 8-year-old study
From October 2001 through January 2002, CDC investigated 100 cases.
On February 5, 2002, he had a stroke. (NOT February 5th)
See the March 2002 issue of Nature.
See the March 29, 2002, issue of MMWR.
In a range of numbers, place the unit of measure after the second number only,
except when there is no space between the number and the unit of measure.
5 × 10 ft
5'× 10'
10–20 grams
10%–20%
70 to 80 mL
70°F–80°F
5¢
$7
$12.50
$1,500
£30.5 million
$10 million OR $10,000,000
Repeat the money symbol sign with each number.
Example: Each tablet costs 10¢ to 50¢.
For a mixture of cents and dollars, use the dollar sign.
Example: Each tablet costs $.90 to $1.50. (NOT 90¢ to $1.50)
33
GRAMMAR AND STYLE
Units of Measure (continued)
Money (continued)
Repeat the word million or billion with each number.
Example: The vaccination program will cost $200 million to $250 million.
Express related amounts the same way.
Example: from $100,000 to $1,000,000 (NOT $100,000 to $1 million)
For fractional numbers, use the number, not the fraction.
Examples: The medication will cost $250,000. (NOT $1⁄4 million)
The medication will cost $500 million. (NOT $1⁄2 billion)
Temperature
Time Period
Do not insert a space between the money symbol (i.e., $, £, ¥, and 1) and the
numeral. However, insert a space if the unit of currency is an abbreviation (e.g.,
CHF, which is the abbreviation for the Swiss Franc).
Examples: $500 £200 ¥700 1600 CHF 300
Do not insert a space between the numeral and the degree symbol. With a range,
repeat the symbol after each number.
Examples: 75°F 28.5°C 60°C–90°C
2 hours
a 24-hour wait
the 1970s (NOT the 1970's)
the ‘70s
the mid-‘70s
the 21st century
during 1995–1998 (NOT 1995–98)
For less precise time frames, use mixed fractions.
Examples: The procedure will last about 31⁄4 hours.
He showed symptoms 21⁄2 days after exposure.
Forms of Numbers
Decimals
If a unit of measure follows the numeral, use the decimal format, not fractions.
1.75 mg (NOT 13⁄4 mg)
2.5 kg (NOT 21⁄2 kg)
If the value is less than 1, insert a zero before the decimal point.
0.2 g (NOT .2 g)
0.9 mg/kg
34
Numbers
Ordinals
Ordinals generally express ranking rather than quantity, so spell out first through ninth,
and use the numeral for 10th and above.
Examples: The fourth patient was admitted in critical condition.
The 12th patient died shortly after his arrival.
When you have a mixture of ordinals below and above nine, use numerals.
Incorrect:
The fifth and the 12th patients showed similar symptoms.
Correct:
The 5th and the 12th patients showed similar symptoms.
Percentages
Use the numeral and the % symbol for specific percentages. Do not insert a space
between the numeral and the symbol (25%). When a number starts the sentence,
spell out both terms.
Examples: Over 90% of the children were vaccinated.
Ninety percent of the children were vaccinated.
In a range of percentages, insert the symbol after each number. However, in a series of
percentages, the symbol follows the last figure only.
Examples: Familial predisposition may be responsible for 5% to 10% of prostate
cancers.
The government received discounts of 10, 20, and 30%.
Important: Only use the word percent with a number; otherwise, use the word percentage.
Incorrect:
A substantial percent of the population does not get enough exercise.
Correct:
A substantial percentage of the population does not get enough exercise.
Formatting and Style Issues
Following are explanations of issues that arise when dealing with numbers.
Punctuation
Abbreviated units of measure do not have a period, unless they close a sentence.
Examples: 50 mg (NOT 50 mg.)
2 dL (NOT 2 dL.)
35
GRAMMAR AND STYLE
Singular and Plural
When the quantity is less than 1, the unit of measure is singular.
Examples: 0.5 gram (NOT grams)
0.2 second (NOT seconds)
When an abbreviated unit of measure follows a quantity, the abbreviation is singular.
Examples: 3 L (NOT 3 Ls)
200 g (NOT 200 gs)
Spacing
Insert a space between the numeral and the symbol, except for %, °C, °F, ° (for angles),
money symbols, fractions, and inches/feet symbols.
25 g
40 mL
60 kg
30%
28.5°C
4”
£250
CHF 50*
51⁄2 years
*A space is added because CHF is the currency abbreviation for the Swiss Franc and
not a symbol.
In mathematical operations or equations, insert a space before and after most symbols
(e.g., +, =, ×, ≥).
E = mc2
50 × 3 = 150
Tip: Word 2000 Shortcut
Inserting the µ and × Symbols
Use µ and × instead of the letters u and x for the microgram and multiplication
symbols.
1. Place the cursor in the text where you want to insert the symbol.
2. On your toolbar, click Insert.
3. Select Symbol.
4. Select the Symbols tag. Under Font, scroll down and select WP MATH A.
5. Choose µ or × (they are on the second line).
6. Click Insert and Close.
Note: Use the same technique for other symbols.
36
Subject and Verb Agreement
Units of measure are treated as collective nouns
and require a singular verb.
Example:
Four hundred micrograms of folic
acid is recommended.
(NOT are recommended)
4 Punctuation
“
Punctuation is the
notation in the sheet
music of our words.
The rules of punctuation are strict and complex. Correct punctuation is critical
to clear writing; incorrect punctuation can confuse the reader or alter the
meaning of a sentence. Proper punctuation makes your text easier to understand,
clarifies ambiguities, eliminates confusion, and accelerates the reading process.
The following list examines the most common types of punctuation problems.
For a more detailed list, consult a grammar book. See the “Bibliography”
section on page 149 for a list of grammar books.
”
Pico Iyer
Apostrophes
Apostrophes often are used incorrectly. However, you need to know only three
simple rules to use apostrophes correctly every time: apostrophes are used in
contractions and with possessive nouns, but NEVER to denote plural.
Use Apostrophes to Denote Contractions
The apostrophe stands for omitted letters or numbers.
Examples: We’re working on a cure.
The disease first appeared in the ’80s.
Because it is too colloquial, avoid using contractions in most business and
professional documents. However, if you are writing brochures or pamphlets
for the public, using contractions may be acceptable and even desirable; it can
give the piece a more readable and approachable tone.
Use Apostrophes to Denote Possessive Nouns
The possessive case denotes ownership or possession and the apostrophe replaces
the word of (children’s health stands for the health of children). Following are
examples of possessive formation. For more details on how to form the
possessive, see the “Possessive” section on page 8.
37
GRAMMAR AND STYLE
Examples:
the vaccine’s availability (singular noun)
the virus’s potency (singular noun ending with an s)
the agencies’ policies (plural noun ending with an s)
women’s health issues (plural noun not ending with an s)
NEVER Use Apostrophes to Denote Plural
This mistake, common with letters and dates, is even perpetuated by the New York
Times, which uses the style “1990’s” instead of “1990s.” However, the s refers to
a plural, NOT a possessive, and an apostrophe should not be used.
Incorrect:
the ABC’s of good dental hygiene
Correct:
the ABCs of good dental hygiene
Incorrect:
Correct:
The disease was eradicated in the 1970’s.
The disease was eradicated in the 1970s.
Brackets
Brackets and parentheses are not interchangeable. Use square brackets in a quotation to
indicate words that are not part of the quote. Also use brackets to enclose words in a
passage that are already in parentheses.
Examples: He added, “At the time the study was done [1998], we had no idea of the
extent of the problem.”
(polycyclic aromatic hydrocarbon [PAH] and polychlorinated biphenyl
[PCB])
Colons
The most common use of colons is to introduce lists and quotes. A complete sentence
must precede a colon, but a complete sentence does not have to follow a colon. Capitalize
the first word after a colon only if it is a proper noun or if it starts a complete sentence.
Use Colons to Introduce Lists
Remember that a complete sentence must precede the colon.
Incorrect:
A healthy lifestyle is based on: eating right and exercising. (A complete
sentence does not precede the colon.)
Correct:
A healthy lifestyle is based on two things: eating right and exercising. (A
complete sentence precedes the colon.)
38
Punctuation
Use Colons to Introduce Quotes
However, if the introductory words do not form a complete sentence, use a comma.
Incorrect:
George Bernard Shaw said: “I often quote myself. It adds spice to my
conversation.” (A complete sentence does not precede the colon.)
Correct:
George Bernard Shaw said something appropriate: “I often quote myself.
It adds spice to my conversation.” (A complete sentence precedes the colon.)
Also Correct: George Bernard Shaw said, “I often quote myself. It adds spice to my
conversation.” (A comma introduces the quote.)
Use Colons for Emphasis
Example:
He had only one interest: genetic research.
Use Colons in Titles
Example:
The Hot Zone: A Terrifying True Story
Do NOT Use Colons After Verbs
Incorrect:
Correct:
Some health risks associated with obesity are: high blood pressure and
high blood cholesterol.
Some health risks associated with obesity are high blood pressure and
high blood cholesterol.
Do NOT Use Colons After Such as, Including, and Consists of
Incorrect:
Correct:
Folic acid has been added to foods such as: enriched bread, pasta, rice,
and cereals.
Folic acid has been added to foods such as enriched bread, pasta, rice,
and cereals.
Commas
Commas are often misused. To ensure proper comma use and placement, first ask
yourself about the rationale for the comma. If you cannot find one, do not insert a
comma. If you are still not sure, look at the examples below to find a justification.
Use Commas With Introductory Elements
An introductory element is a word, phrase, or clause that appears at the beginning of
the sentence, before the independent clause.
Examples: After the results came in, the physician contacted the patient.
However, the disease is not contagious.
39
GRAMMAR AND STYLE
Use Commas With Contrasting Elements
Commas can emphasize two contrasting points or ideas in a sentence. Generally, a
word introduces the contrast (e.g., not, but, yet, never, although).
Examples: He contracted the flu, not pneumonia.
We thought we had the result, but didn’t.
Use Commas With Two Independent Clauses Joined by a Coordinating Conjunction
Only seven coordinating conjunctions exist in the English language. An easy way to
remember them is with the acronym FANBOYS (for, and, nor, but, or, yet, so).
Tip: Coordinating Conjunctions
If you are not sure whether a comma is required, ask these two questions:
1. Can the two clauses stand by themselves?
2. Does the sentence have one of the FANBOYS?
Remember the Conjunctions
F
A
N
B
O
Y
S
for
and
nor
but
or
yet
so
If the answer is YES to BOTH questions, insert a comma before the conjunction.
Incorrect:
The flu vaccine is available, and is being distributed locally.
(An independent clause does not follow the conjunction.)
Correct:
The public health system is adequate, and the public can feel safe.
(Two independent clauses surround the comma.)
Use Commas With Coordinate Adjectives (Consecutive Adjectives)
Coordinate adjectives (two or more adjectives that modify a noun or pronoun) are
separated by a comma. Adjectives are coordinated if you can switch their order without
changing the meaning of the sentence or if you can insert and between the adjectives.
Incorrect:
He had a big, cold sore. (The sore is not big and cold, the cold sore is big.
Because you cannot insert and, the adjectives are not coordinated.)
Correct:
He had a big cold sore.
Incorrect:
Correct:
He had a big cold glass of water in his hand. (The glass is big and cold.
Because you can insert and, the adjectives are coordinated.)
He had a big, cold glass of water in his hand.
Use Commas With Nonrestrictive Elements
If the section of the sentence surrounded by commas can be removed from the
sentence without changing the meaning of the sentence, use commas. Nonrestrictive
elements usually occur in the middle of sentences and can be one or several words.
Example:
The condition, which affects several million people every year,
is preventable.
40
Punctuation
However, consider these examples:
Example 1: Editors who are too picky are a nuisance.
Example 2: Editors, who are too picky, are a nuisance.
Example 1 is restrictive because it is limited only to the picky editors (not all editors are
picky). Example 2 is nonrestrictive because it implies that all editors are picky.
Both sentences are grammatically correct. However, the absence or presence of the
commas changes the meaning of the sentences. The issue here is not placing the
commas in the right or wrong spots, but using or omitting them to convey the intended
meaning.
Use Commas With Dates and Geographic Locations
When writing the complete date, put a comma before and after the year.
Example:
He attended a symposium in Paris, France, on March 10, 2002, and
returned on March 15, 2002.
Do not place a comma between month and year.
Example:
Toxic fumes were released between December 2001 and
February 2002.
Use Commas With Series and Lists
Use commas to separate series of three of more terms. Also insert a comma before the
last conjunction (called a serial comma).
Example:
Eat a balanced meal, exercise, drink plenty of fluids, and avoid stress.
Use Commas With Direct Quotes
Often, a colon introduces a quote. However, if the introductory words do not form a
complete sentence, use a comma.
Incorrect:
Louis Pasteur said: “Chance favors only the prepared mind.”
(A complete sentence does not precede the colon.)
Correct:
Louis Pasteur said, “Chance favors only the prepared mind.”
(A comma introduces the quote.)
Use Commas With Attribution
In most cases, use a comma instead of a period at the end of a quote that precedes an
attribution.
Example:
“We have the situation under control,” the health official said.
41
GRAMMAR AND STYLE
Use Commas With Age, Degrees, and Titles
Examples:
Ben Sisko, 45, attended the seminar.
Phil McGraw, Ph.D., was the guest speaker.
Jonathan Archer, vice-chair, attended the hearing.
Use Commas With Large Numbers
Use a comma with figures greater than 999, except in addresses.
Examples: He collected 1,243 samples for his test.
CDC’s main campus is located at 1600 Clifton Road.
Tip: Word 2000 Shortcut
Dashes
Inserting the en or em Dash
Place the cursor where you want to insert the symbol in the text.
1. On your toolbar, click Insert.
2. Select Symbol.
3. Under Font, select (normal text).
4. Scroll down until you find the appropriate symbol.
5. Click on the symbol.
6. Click Insert and close the window.
There are two dashes of different lengths: the en dash (–), and
the em dash (—). The hyphen (-), technically not a dash, often
is used incorrectly in lieu of a dash (for more details, see the
“Hyphens” section on page 43). However, these elements should
NOT be used interchangeably, as the examples below illustrate.
Note: Do not insert a space between the dash and its
surrounding elements.
En Dash
Use the en dash to indicate ranges.
Examples: 1990–1995
12–15 mg
40%–50%
Em Dash
Use the em dash for emphasis, to indicate a change in thought, or to separate a series of
words.
Examples: He came to the meeting—for the first time ever—and spoke up.
We will have the results of the tests soon—if the laboratory is open.
He mentioned the benefits—improved muscle tone and weight loss—of
regular exercise.
42
Punctuation
Ellipses
An ellipsis indicates the deletion of words in text or in a quote. An ellipsis is made up of
three periods separated from each other and from surrounding text by a space ( . . . ).
Example:
We have not journeyed across the centuries . . . because we are made of
sugar candy.
In the preceding quote by Churchill, the words omitted are, “across the oceans, across
the mountains, across the prairies.”
If a new sentence starts after the ellipsis, use four periods. Do not insert a space before
the first period.
Example:
We shall fight on the beaches. We shall fight on the landing grounds. . . .
We shall never surrender!
Churchill’s complete quote was, “We shall fight on the beaches. We shall fight on the
landing grounds. We shall fight in the fields, and in the streets, we shall fight in the
hills. We shall never surrender!”
Hyphens
A hyphen connects words to make them more understandable. Some words are always
hyphenated (state-of-the-art, up-to-the-minute); others are temporarily hyphenated to
clarify or prevent ambiguity (well-known, re-create). A compendium of frequently
occurring hyphen use follows. For a more complete list of rules, consult the AMA
Manual of Style.
Hyphenate Nouns Combined With Adjectives
Example:
A fat-free, high-fiber, low-cholesterol diet will help you lose weight.
Hyphenate Nouns Combined With Nouns
The hyphen indicates that the two nouns are of equal value or have common
characteristics.
Examples: She is a writer-editor at CDC.
Women should consult an obstetrician-gynecologist once a year.
43
GRAMMAR AND STYLE
Hyphenate Time Periods Used as Modifiers and Numbers
Examples:
The month-long investigation yielded some results.
There is a 10-day waiting period to enroll in the program.
Twenty-five people contracted the disease.
Hyphenate Fractions
Hyphenate fractions used as adjectives. However, do not hyphenate fractions used
as nouns.
Examples: A two-thirds majority is needed. (Two-thirds is an adjective and requires
hyphenation.)
Two thirds of the patients did not respond to the medication. (Two thirds
is a noun and is not hyphenated.)
Hyphenate Compound Proper Nouns
Hyphenate compound proper nouns when they function as adjectives. However, do not
hyphenate them when they function as nouns.
Examples: Pre-term birth is the leading cause of death among African-American
infants. (African-American is an adjective.)
African Americans suffer disproportionately from chronic and
preventable diseases. (African Americans is a noun.)
Hyphenate to Avoid Ambiguity
Hyphenate numerals, re- words, or any other words to avoid ambiguity. In the
following examples, the presence or absence of the hyphen alters the meaning.
Examples: The 10 year-old children were vaccinated. (Ten children who are 1 year
of age)
The 10-year-old children were vaccinated. (All the children who are 10
years of age)
Examples:
The mathematician resolved the equation. (She found a solution.)
The mathematician re-solved the equation. (She had to do the equation
again.)
Examples:
He has a small bowel problem. (A small problem concerning his bowel)
He has a small-bowel problem. (A problem concerning his small bowel)
Do NOT Hyphenate Adverbs Ending in ly
Example:
44
Chickenpox is a highly contagious disease.
Punctuation
Do NOT Hyphenate Medical Conditions, Latin and Foreign Expressions, or the Full
Names of Chemical Compounds
Do not hyphenate these if they are used as adjectives.
a priori
per diem
in situ
in vivo
in vitro
hydrogen sulfide gas
sickle cell anemia squamous cell carcinoma
ex officio*
*Hyphenate ex- only when it is a prefix meaning former (ex-director). The ex in
ex officio is not hyphenated because it is Latin for out of or without and therefore
not a prefix.
Do NOT Hyphenate Most Prefixes
Do not hyphenate most prefixes unless they precede a proper noun, a capitalized word,
or an abbreviation (see the exceptions below).
Examples: The American Cancer Society is a nongovernment agency.
Information is also available for non-English speakers.
Examples:
Subatomic physics encompasses nuclear and elementary particle physics.
Sub-Saharan Africa has more than 28 million HIV/AIDS sufferers.
Do NOT hyphenate the following prefixes.
ante
anti
bi
counter
de
extra
intra
micro
mid
over
pre
post
re
semi
sub
tri
ultra
un
co
infra
neo
pro
supra
under
contra
inter
non
pseudo
trans
Exceptions
Always hyphenate all-, ex- (when it means former), and self-.
Examples: The tobacco lobby is an all-powerful force.
The ex-surgeon general was on CNN last night.
A self-support group can help those who want to quit smoking.
Also hyphenate the prefix if the spelling would be awkward or difficult to read without
it, for example if the letter ending the prefix and the one starting the word are the same
(anti-infective, intra-aortic, re-enter, shell-like).
Example:
Aspirin is a common anti-inflammatory drug.
45
GRAMMAR AND STYLE
Parentheses
Use parentheses sparingly, because they tend to break the reader’s concentration. Use
them only when you must insert background or reference information. Remember
William Safire’s words: “Parenthetical remarks (however relevant) are unnecessary.”
Examples: Entitlement programs (e.g., Medicare, Medicaid) and the Americans with
Disabilities Act are examples of national policies.
The number of older adults (those aged 65 years or older) has increased
11-fold in the past century.
Periods
When to Use Periods
Use periods with abbreviations, such as degrees (M.D., Ph.D.), states (Ala.), and titles
(Mr., Dr.).
When NOT to Use Periods
Do not use periods with such words as CDC or ATSDR; these are acronyms, not
abbreviations. Never end a title, heading, or subheading with a period because it slows
the reading process.
Quotation Marks
With direct quotes, place periods and commas inside quotation marks; place colons,
semicolons, and question marks outside of quotation marks unless they are part of the
quote.
Examples: “We are working on a cure,” he said.
“What are our next steps?” he asked.
Avoid using quotation marks as an apology for a word or phrase. Either omit the
quotation marks or use another term.
Avoid:
We used the “gold standard” method of…
Better:
We used the gold standard method of…
Best:
We used the most valid method of…
46
Punctuation
Semicolons
Semicolons convey separation of thought and information.
Use Semicolons to Link Independent Clauses
Use a semicolon between two independent clauses instead of a conjunction
(e.g., and, or) or before a conjunctive adverb (e.g., however, therefore, thus).
Examples: The tests came back yesterday; they were inconclusive.
Tuberculosis is a serious disease; however, it is treatable.
Use Semicolons to Separate Items That Have Internal Commas
Example:
In attendance were Dr. Black, EPA; Dr. Brown, CDC; Dr. White,
NIH; and Dr. Green, ATSDR.
Use Semicolons to Clarify Several Individual Clauses
Example:
He stopped drinking, gave up fatty foods, became a vegetarian,
and took up running; but even with these changes, he still had
high cholesterol.
47
48
5 Words
“
Proper words in
proper places make
the true definition
Mark Twain once wrote, “The difference between the right word and the
almost right word is really a large matter—‘tis the same as that between
lightning and the lightning bug.” Choosing the right words to express facts,
thoughts, and ideas is crucial to good writing. Using a word improperly or
using the wrong word dilutes the impact of our writing and can change the
meaning of a sentence or a document.
The first section of this chapter, “Inclusive Language,” presents guidelines on
using language to describe people in an unbiased manner. The next section,
“Word Definitions,” discusses the proper use of words that are sometimes
misused and provides examples of proper use. The last section, “Vocabulary
Issues,” addresses vocabulary problems and mentions alternatives to
redundancies and jargon.
of a style.
”
Jonathan Swift
Inclusive Language
When describing people, avoid using biased language. Following are guidelines
on proper language use.
General Terminology
disability, handicap, normal, abnormal
Disability refers to a condition that limits a person’s ability to carry out a
function. Avoid using handicap, which is a judgmental term. When comparing
persons with disabilities to others, use the term nondisabled person or person
without disabilities rather than normal person, because normal is associated
with abnormal.
49
GRAMMAR AND STYLE
Put people first, not their disability, and avoid depersonalizing terms such as epileptic
or diabetic.
Avoid:
disabled person, epileptic, diabetic, asthmatic
Use:
person with (who has) a disability, person with epilepsy, diabetic patient,
boy with asthma
gender, sex
Gender is a grammatical term that denotes whether a noun is masculine, feminine, or
neutral. However, gender has evolved to also refer to the categories of man and woman,
which are based mainly on the sex of the person. Sex refers to the biologic characteristics
of males or females. Use sex and not gender to refer to people’s sex, unless the context
might cause confusion, as in this example: sex is a risk factor for HIV.
Following is a list of gender-neutral terminology.
Avoid
Use
chairman, chairwoman
congressman
fireman
layman
mailman
man, mankind
mothering
policeman, policewoman
postman
repairman
spokesman, spokeswoman
chair, chairperson
member of Congress, representative, legislator
firefighter
layperson
mail carrier, letter carrier
people, humans, human beings, humanity, humankind
parenting
police officer
postal worker
maintenance worker
spokesperson
individual, person
Because the term individual is dehumanizing, change individual(s) to person(s) unless
you need to distinguish individuals from a class or group.
Example:
Both individuals and institutions participated in the test.
male, female; men, women
When distinguishing the sex of adults, use the nouns men and women; for children, use
boys and girls; for adolescents, use (as appropriate) boys and girls or young men and
50
Words
young women. Avoid using male and female as nouns unless a group contains both
children and adults.
Example:
The males [boys and men] were at higher risk than the females [girls and
women].
people, persons
Strictly, people is correct for a large, indefinite group (European people) and persons is
correct for an exact or small group (12 persons in the study). However, some critics
consider that persons is pedantic and stodgy and that people is the plural of person.
Age
Avoid vague terms such as school-aged children, teenagers, older women without first
defining them (i.e., infants aged 5 months to 1 year, children aged 6–12 years, adolescents
aged 13–17 years, women older than 65 years).
A youth is one young person (usually a young boy or young man). Youth can refer to
young people in general (the youth of the United States). In either case, it is a singular
noun. Therefore, avoid constructions such as “risk behaviors among youth” (NOT
youths) and “too many youth smoke.” Replace with young people or adolescents.
Following are AMA’s age designations.
Neonates or newborns
Infants
Children
Adolescents
Adults
birth to 1 month
1 month to 1 year
1 year through 12 years. Sometimes, children may be used to include
newborns and infants. Children may also be referred to as boys or girls.
13 years through 17 years. They may also be referred to as teenagers or
as adolescent boys or adolescent girls, depending on the context.
18 years or older. Refer to them as men or women.
Race or Ethnicity
When race and ethnicity are relevant, make sure you use the correct term. Below is an
explanation of different classifications of race and ethnicity. For a complete list of race
and ethnicity classification, consult the Office of Management and Budget at
http://www.whitehouse.gov/omb/fedreg/ombdir15.html.
51
GRAMMAR AND STYLE
Alaska Native (Aleuts, Eskimos, Indians of Alaska), Alaskan
An Alaska Native (NOT Alaskan Native) is a person whose origins are in any of the
original peoples of Alaska and who maintains cultural identification through tribal
affiliation or community attachment. An Alaskan is anyone who was born in Alaska
or who is a long-term resident of Alaska.
American Indian or Native American
An American Indian is a person whose origins are in any of the original peoples of North,
Central, or South America (except Alaska) and who maintains cultural identification
through tribal affiliation or community attachment. Whenever possible, specify the nation
or people (e.g., Navajo, Nez Perce, Inuit) rather than use the more general term.
Asian
An Asian is a person whose origins are in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, The Philippines, Thailand, and Vietnam. Do
not use the word oriental (rugs are oriental, not people).
Black or African American
An African American is a person whose origins are in any of the black racial groups
of Africa. If appropriate, specific terms such as Haitian or Bahamian may also be used.
When discussing scientific data, use the term that was used when the research (the
source of the data) was being conducted. Put the word black in lowercase letters.
Do not hyphenate African American as a noun; however, hyphenate it as an adjective.
Examples: In 1998, African Americans represented 48% of all reported persons with
AIDS in the United States. (African Americans functions as a noun.)
In 1998, AIDS was diagnosed in 6,600 African-American women in the
United States. (African-American functions as an adjective.)
Hispanic or Latino
A Hispanic is a person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race. The term Spanish origin may also be
used. Because the terms are vague, use the more specific geographic origin, if possible.
Native Hawaiian or Other Pacific Islander
A Native Hawaiian is a person whose origins are in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific islands. It does not include a person who is
native to the State of Hawaii by virtue of being born there. Other terms such as Part-
52
Words
Hawaiian may also be used when appropriate. Note: Capitalize Part-Hawaiian because
it is a legal status. However do not capitalize part with other nationalities (example:
part-Japanese).
White
This is a person whose origins are in any of the original peoples of Europe, the Middle
East, or North Africa. Do not capitalize white, unless it starts a sentence. Avoid the term
Caucasian because it technically refers to people from the Caucasus region.
Sexual Orientation
Sexual orientation should be mentioned only when scientifically relevant. Use the
term sexual orientation and not sexual preference. Because they are either too vague or
pejorative, avoid using homosexual or gay as nouns. Using these terms as adjectives is
acceptable (homosexual man, gay man). Use lesbians and gay men when referring to
specific groups.
Vague:
homosexuals (the term does not specify the sex)
Clear:
gay men, lesbians, bisexual persons, heterosexual persons
Word Definitions
Tip: Word 2000 Shortcut
Finding the Right Word
Many words in the English language are similar in meaning or sound alike, and
even the best writers occasionally have questions about their usage. Following
is an alphabetical list of words that are frequently used improperly.*
To use the Thesaurus:
Place the cursor on the word.
Press Shift + F7.
abort
Abort means “to stop in the early stages.” A pregnancy, but not a fetus or a woman, may
be aborted.
Incorrect:
The fetus was aborted.
Correct:
The pregnancy was aborted.
Better:
The pregnancy was terminated.
absorption, adsorption
Absorption indicates an active, ongoing process in which something is taken up by
something else by various physical actions.
Example:
The absorption of spilled juice into a paper towel occurs by
capillary action.
* This list is adapted from Medical English Usage and Abusage by Edith Schwager, The American Heritage Book of English Usage: A Practical and Authoritative
Guide to Contemporary English, and the CBE Manual for Authors, Editors, and Publishers. Other contributions were provided by CDC’s National Center for
Infectious Diseases, National Center for Environmental Health, and National Center for Chronic Disease Prevention and Health Promotion.
53
GRAMMAR AND STYLE
Adsorption describes the holding or accumulation of something, such as a gas, a liquid,
or a solute (a substance that has been dissolved in another substance) on the surface of
a solid or liquid.
Example:
The removal of dissolved gases from tap water is achieved by their
adsorption onto a substance such as activated charcoal.
acute, chronic
Use these terms to describe only the duration—not the severity—of symptoms,
conditions, or diseases. Acute diseases have a sudden onset, sharp rise, and short course.
Chronic diseases are marked by long duration or frequent recurrence. Avoid using
these terms to describe people (e.g., avoid expressions such as chronic smokers).
Examples: CDC focuses on identifying risk factors for chronic diseases, which are
illnesses that are prolonged, do not resolve spontaneously, and are rarely
cured completely.
Up to 25% of injuries that require acute care in the United States are
alcohol related.
ad, exam, lab
These are examples of short forms of words; they should not be used in formal writing.
affect, effect
The verb affect means “to produce an effect upon;” the noun affect is a rarely used
psychology term that refers to the immediate expressions of emotion. The verb effect
means “to bring about” or “to cause;” the noun effect means “a distinctive impression.”
Examples: The noise affects [does something to] my hearing.
Her affect [attitude] belied her words.
The effect [results] of the new policy will be noticeable.
The new policy will effect [produce] a new attitude among employees.
although, while
Use while only to connote time. Otherwise, use although.
Examples: He contracted the disease while traveling abroad. (While refers to the
period of time he was abroad.)
Although we didn’t yet know the results of the first study, we set up the
second study.
54
Words
among, between
Use among with objects denoting three or more persons or things. Use between with
objects denoting two persons or things.
Examples: There were sharp disagreements among the five panelists.
There was a sharp disagreement between the two scientists.
amount of, number of
Use amount of for noncountable nouns (amount of water, work, light). Use number of
for countable nouns (number of experiments, studies, test tubes).
Examples: Even small amounts of lead exposure can result in learning and
behavioral problems among children.
A review of a number of studies on the use of DES among pregnant
women showed that the drug had no effect on reducing the risk of
miscarriage.
and/or
Avoid using slashes instead of words; instead use and or or. In most cases use or, which
allows for either of two options and does not preclude that both options may pertain.
Example:
The women worked at the plant or lived near it.
assure, ensure, insure
Assure means “to inform confidently.” Ensure means “to make certain.” Insure means “to
guarantee life or property against loss.”
Examples: The health inspectors assured the public that the water was safe to drink.
To ensure your safety, keep your seat belt fastened at all times.
We insured our new car yesterday.
to author, to write
Use to write.
avert, avoid
Avert means “to prevent” or “to ward off.” Avoid means “to keep clear of” or “to shun.”
Examples: Because he acted quickly, the danger was averted.
Because he didn’t ski, he avoided the risk of breaking a leg.
55
GRAMMAR AND STYLE
based on, on the basis of
Use based on only after some form of the verb to be or implied verb to be.
Incorrect:
Based on these data, we can reasonably assume that smoking causes cancer.
Correct:
On the basis of these data, we can reasonably assume that smoking causes
cancer.
Correct:
The assumption that smoking causes cancer is based on these data.
between . . . and, from . . . to, from . . . through
These expressions are not synonymous because they imply different time frames.
Between June and October covers July, August, and September; it does not include
June or October. From June to October covers June, July, August, and September; it
does not include October. From June through October covers June, July, August,
September, and October.
biannual, biennial
Biannual means “twice a year;” it is a synonym for semiannual. Biennial means “every
2 years.”
Examples: During the early 1980s, biannual national vaccination campaigns
substantially reduced the number of polio cases in Brazil.
The 10th Biennial Symposium on Statistical Methods was held in 2001.
The 11th symposium will be in 2003.
biopsy
Biopsy is the procedure of removing and examining tissue, cells, or fluids from the
body. Do not use it as a verb. Observations are made on the biopsy specimen, not on
the biopsy itself.
Example:
The biopsy specimen should contain a minimum of 10 hair follicles.
case, patient
A case is an instance, example, or episode of disease. Do not use case to refer to a
patient. A patient is a person under medical care for a disease.
Examples: The small child had a case of chickenpox.
The physician examined five patients.
caesarean delivery, caesarean section
The preferred terms are caesarean delivery, caesarean birth, or abdominal delivery.
Example:
An elective caesarean delivery increases the risk to the infant of premature
birth and respiratory distress syndrome.
56
Words
cohort
A cohort describes a group of individuals who have a statistical factor (such as age or
class) in common in a demographic study. A cohort does not refer to one individual.
Example:
In his paper on asbestos-related mortality in insulation workers from
1943 to 1976, the researcher found marked increases in death due to lung
cancer in this occupational cohort.
compared to, compared with
Use compared to to make an analogy or to compare dissimilar items. Use compared with
when comparing items that are in some way related. In scientific writing, compared
with is almost always correct.
Examples: The human heart can be compared to a pump (both move fluids).
The human heart can be compared with a canine heart (it has the same
number of chambers but it is larger, beats at a different rate, etc.).
compendium
A compendium summarizes a larger work; it is NOT a comprehensive work.
Example:
The Compendium of HIV Prevention Interventions with Evidence of
Effectiveness lists the findings of CDC's HIV/AIDS Prevention Research
Synthesis Project.
compose, comprise
Compose means “to be made of,” “to include,” or “to contain,” and takes the passive voice.
Example:
Fuel oils are composed of many chemicals.
Comprise means “to be composed of” or “to consist of;” the whole comprises its parts,
never the reverse. Comprise takes the active voice. Never use to be comprised of.
Incorrect:
The United States is comprised of 50 states.
Incorrect:
Fifty states comprise the United States.
Correct:
The United States comprises 50 states.
concentration, level
In medical usage, concentration describes a quantity set within the context of another
quantity. Thus, the relative content of any substance that is dissolved or dispersed
within a solution or mixture is referred to as the concentration of that substance.
Example:
We detected arsenic in the soil in concentrations ranging from
2.1 to 17 parts per million.
57
GRAMMAR AND STYLE
Level is usually descriptive rather than quantitative, conveying a sense of the relation
a particular range of concentrations has to a standard or normal concentration of
a substance.
Example:
Blood lead levels of 10 g/dL or more in children are considered elevated.
congenital, heritable
Congenital conditions or characteristics are usually not part of the organism’s normal
genetic makeup. Congenital describes conditions or traits that are acquired, either at
birth or during development in the uterus. Most often, congenital indicates that some
factor, such as a drug, a chemical, an infection, or an injury, has upset the careful timing
and balance of the developmental process in a way that adversely affects the fetus.
Example:
A baby born with spina bifida most likely cannot pass this congenital
condition on to future generations.
Heritable characteristics or conditions are intrinsic to the genetic makeup of an
individual and are capable of being passed from one generation to the next.
Example:
A baby born with a heritable disease, such as hemophilia, can pass the
disease on to future generations.
connote, denote
Connote suggests or implies something. Denote means “to be explicit.”
Examples: The results of the study connote that an increase in fruit and vegetable
consumption leads to reduced risk for heart disease and cancer.
The symbol “P < .05” denotes that the results of the study are significant
and did not occur by chance alone.
contagious, infectious
Contagious refers to a disease that can be transmitted from one living being to another
through direct contact (as with measles) or indirect contact (as with cholera).
Example:
Chickenpox is an acute contagious disease.
The agent responsible for the contagious character of a disease is described as being
infectious, the usual culprits being microorganisms, such as viruses and bacteria, or
macroorganisms, such as fungi or parasitic worms.
Example:
Louis Pasteur discovered that most infectious diseases are caused by germs.
contraception, contraceptive
Contraception is the practice of preventing pregnancy. Contraceptive is the method used
for contraception.
58
Words
Examples:
Popular methods of contraception include birth control pills and condoms.
The pill is the leading contraceptive method among women under age 30.
contract, develop
Patients do not develop diseases; they contract diseases. Diseases develop in patients.
Incorrect:
The patient developed brucellocis after ingesting contaminated milk.
Correct:
The patient contracted brucellocis after ingesting contaminated milk.
critical patient
Patients are not critical, but their status or condition is.
Incorrect:
The patient was critical.
Correct:
The patient was in critical condition.
diagnose
Conditions, diseases, and disorders are diagnosed, not patients.
Incorrect:
The child was diagnosed with rubella.
Correct:
The physician diagnosed rubella.
die of, die from, die with
People die of, not from, a condition or disease. People can also die with a disease that is
not the immediate cause of death.
Example:
The elderly man died of injuries sustained in a car crash and with
Alzheimer disease.
doctor, physician
Doctor is a title applying to those who hold advanced degrees (e.g., Ph.D., D.D.S, D.V.M.).
Physician refers to a doctor of medicine. Do not use the title and the degree together.
Incorrect:
Dr. Stephen Jay Gould, Ph.D.
Correct:
Dr. Stephen Jay Gould
Correct:
Stephen Jay Gould, Ph.D.
dose, dosage
Dose means “the amount to be taken at one time.” Dosage means “the amount (doses)
to be taken over a period of time.”
Examples: Give the vaccine over a period of time, in a series of properly spaced doses.
New drugs are usually introduced in low dosages and gradually increased
over time.
59
GRAMMAR AND STYLE
due to, because of
Use due to only after some form of the verb to be or implied verb to be. Never begin a
sentence with due to. If due to could be replaced with caused by, it is correct.
Incorrect:
He succeeded due to his hard work and great talent. (Caused by cannot be
substituted, therefore due to is incorrect.)
Correct:
His success was due to hard work and great talent. (Due to is correct
because you can substitute caused by.)
e.g., etc., i.e.
Use e.g., (exempli gratia: for example), etc., (et cetera: and others), and i.e., (id est: that
is) with care; they have different meanings.
The abbreviation e.g., is followed by an example or an incomplete list of examples.
Example:
Certain behaviors are harmful (e.g., smoking, drinking, overeating).
The abbreviation i.e., does not introduce an example; it indicates that what follows is
an explanation or clarification of what has just been said. If a complete list follows,
insert a conjunction before the final item in the list.
Example:
We studied three harmful behaviors (i.e., smoking, drinking,
and overeating).
Use etc., with discretion, and never after an example or list of examples. Because a list
of examples implies that not every item is included, etc. is redundant.
Incorrect:
To be successful, investigators need certain characteristics (e.g., leadership
ability, curiosity, tenacity, etc.).
Correct:
To be successful, investigators need certain characteristics (e.g., leadership
ability, curiosity, tenacity).
Use e.g., and i.e., only within parentheses. Otherwise spell out for example and that is.
Example:
We studied several types of behaviors; for example, we studied teenagers’
tendency toward risky behavior.
e-mail
Use e-mail rather than email or E-mail.
endemic, epidemic, pandemic
Endemic describes a disease (or characteristic) that is restricted to a particular region,
such as cholera and plague in parts of Asia. A disease is endemic in an area; the area is
not endemic. Epidemic refers to a disease that involves many more people than usual in a
60
Words
particular community or a disease that spreads into regions in which it does not normally
occur. Pandemic is the outbreak of a disease occurring over a wide geographic area and
affecting a large number of people.
Examples: Cholera is endemic on the Indian subcontinent and in Sub-Saharan Africa.
Occurrences of influenza often result in epidemics.
HIV/AIDS is pandemic in Africa.
enhance
Enhance means “to heighten” or “to increase,” especially to improve in value, quality,
desirability, or attractiveness. Avoid using enhance to indicate an increase in an
undesirable outcome. Enhance could be replaced with improve, heighten, increase,
elevate, enlarge, or augment.
Avoid:
Smoking enhances the risk for lung cancer.
Use:
Smoking increases the risk for lung cancer.
etiology, cause
Etiology is the study or description of causes or origins of a disease, not the immediate
cause of a disease.
Examples: The etiology of cancer is a maze of unknowns.
The cause of heart failure was acute myocardial infarction.
exercise, physical activity
Exercise is planned, structured, and repetitive bodily movement done to improve or
maintain one or more components of physical fitness. Physical activity is any bodily
movement produced by skeletal muscles that results in energy expenditure.
Examples: These exercises can be done while sitting at your desk.
Even moderate physical activity, such as walking, can result in health
benefits.
farther, further, furthermore
Use farther only in relation to distance. Further can be used for any greater degree,
greater extent, or greater distance. Furthermore means “in addition to what has just
been said.” Avoid using further for furthermore.
Examples: With the increasing level of noise in urban areas, many families are
moving farther away from cities.
The center calls for further research on ways to minimize risk of hearing
loss in the workplace.
Furthermore, additional recommendations for preventing hearing loss
should be included in the report.
61
GRAMMAR AND STYLE
fever, temperature
Fever is a rise in body temperature above normal. A person’s temperature is either normal
or abnormal. Everyone has a temperature. Do not use temperature if fever is intended.
Example:
If the patient has a temperature of 37.8˚C, he has a fever of 0.8˚C.
fewer, less
Use fewer with countable units and less with noncountable units.
Example:
We collected fewer blood samples for this study, and we collected less
blood from each person.
follow, follow up, follow-up, followup
Follow and follow up (two words) are verbs; follow-up (hyphenated) is an adjective;
followup (one word) is a noun. Cases (instances of disease) and clinical courses may be
followed. Patients or study subjects are not followed; they are observed. One can follow
up on either cases or patients.
Examples: They must follow strict research protocols. (Verb)
The clinician followed up with her patients. (Verb)
Followup occurs 24 hours after the drug is administered. (Noun)
CDC conducted a follow-up study on the effects of pollutants in the
environment. (Adjective)
germ, microbe, microorganism, pathogen
Germ and microbe are nontechnical terms describing a living organism, especially one
invisible to the naked eye, that can cause diseases. The technical term is pathogen, which
describes an agent that causes diseases, especially a bacterium, fungus, or other
microorganism.
Examples: Disinfect areas where there are both high concentrations of dangerous
germs and a possibility that they could spread to others.
Drug resistance occurs when microbes develop ways to survive medicines
meant to kill or weaken them.
The pathogens under surveillance in FoodNet include E. coli and Salmonella.
Microorganism is a general term that describes all one-celled microscopic organisms,
both disease-causing and benign.
Example:
Many microorganisms, such as typhoid bacillus, are adapted exclusively
to humans.
62
Words
good, well
The adjective good and the adverb well are not interchangeable. Good means “something
that is as it should be;” it qualifies a noun (good data). Well means “satisfactorily;” it
qualifies a verb (to eat well).
Examples: The study produced good results. (Good qualifies the noun results.)
The study went well. (Well qualifies the verb to go.)
-ic, -ical
Omit the al when it is unnecessary (e.g., use epidemiologic rather than epidemiological,
biologic rather than biological). However, the meaning of some words changes
depending on the ending. For example, historic refers to something that is famous in
history, whereas historical refers to something that is about history or based on history.
Examples: Thomas Jefferson is featured in many historical novels.
Thomas Jefferson participated in many historic events.
immunize, vaccinate
To immunize means “to confer immunity.” To vaccinate means “to administer a vaccine.”
Example:
People who were vaccinated against smallpox may no longer be
immunized against the disease.
incidence, prevalence
Incidence refers to the rate of occurrence, such as the number of new cases of a disease
occurring at a certain time. Prevalence is the total number of cases (or percentage) of a
disease existing at a certain time in a certain area. Incidence expresses the number of
new cases, whereas prevalence expresses the total number of cases.
Examples: The highest incidence of acute hepatitis C (HCV) is found among
persons aged 20 to 39 years.
The highest prevalence of HCV infection is found among persons aged 30
to 49 years.
include
Include (and includes, included, including) precedes an incomplete list only.
Incorrect:
The United States includes 50 states.
Correct:
The United States includes Alaska and Hawaii.
infer, imply
Infer means “to draw a conclusion from evidence.” Imply means “to suggest without
actually stating.” Usually the speaker or writer implies, and the listener or reader infers.
Examples: We can infer from this study that PCBs cause cancer in animals.
The latest study implies that PCBs also cause cancer in humans.
63
GRAMMAR AND STYLE
inject, inoculate
Medications, preparations, and drugs are injected, not patients or animals.
Incorrect:
The physician injected the patient with insulin.
Correct:
The physician injected insulin into the patient.
You inoculate an animal or patient with something.
Example:
We inoculated each mouse with 0.5-mL aliquot.
Internet
Capitalize Internet.
lay, lie
To lay means “to place;” laid is the past tense. To lie means “to be in a reclining position;”
its past tense is lay. To lie can also mean “to make an untrue statement;” its past tense
is lied.
Examples: I asked him to lay the folder on my desk. He laid the folder on my desk
yesterday.
He is depressed and lies in bed all day. He lay in bed yesterday.
You can’t believe him; he lies all the time. He lied yesterday.
may, might
Both indicate possibility or probability. Strictly, may is present tense, might is past tense.
Examples: He believes he may be ill.
He believed he might have been ill.
Often may and might are used interchangeably, with may indicating more certainty
than might.
Example:
The study may answer some questions and might answer all of them.
Might rather than may is correct in hypothetical situations.
Example:
Had they known the results, the members might have concluded
differently. (NOT may)
maximize, maximal, minimize, minimal
Maximize means “to increase to the greatest amount possible,” not simply “to increase.”
Maximal means “the upper limit,” “the most comprehensive,” not “somewhat more” or
“much more.”
64
Words
Examples:
CDC has guidelines on how to freeze food to maximize safety and
freshness.
The maximal retention calcium intake for adolescents is 1,300 mg/d.
Minimize means “to decrease to the least amount possible,” not simply “to decrease.”
Minimal means “the least possible,” not “somewhat less” or “a lot less.”
Examples: To minimize your exposure to farm pesticides, wear appropriate
protective gear.
The cost of tracking our progress will be minimal.
methodology
Methodology is the study of methods or a body of methods, rules, and postulates.
Otherwise, use method(s).
Example:
After completing a course on audience research methodology, we decided
to use qualitative research methods, including focus groups and interviews,
to develop messages for CDC’s folic acid campaign.
molecular weight
Molecular weight means “the relative mass of a substance.” It is a pure number and has
no units.
Incorrect:
The molecular weight of the protein is 30,000 daltons.
Correct:
The molecular mass of the protein is 30,000 daltons.
Correct:
The molecular weight of methane is 16.
morbidity
Morbidity means both “the relative incidence of disease” and “the condition of being
diseased.” Change morbidity to illness, disease, or condition when writing for lay audiences.
Example:
Millions of people suffer from illnesses that can be prevented or improved
through regular physical activity. For example, the morbidity rate for
heart disease is 135 per 100,000 Americans.
mortality, mortality rate, fatality
Mortality means “the number of deaths per standard unit of population per unit of
time.” Change mortality to death for lay audiences. Mortality rate means “the number of
deaths per number of persons at risk,” as in infant mortality rate (the ratio of numbers
of infant deaths during a calendar year to the total number of live births during that
year). Distinguish mortality from fatality. Fatality is a death resulting from
a disaster.
65
GRAMMAR AND STYLE
Examples:
Breast cancer mortality rates declined significantly during 1992–1998.
One of the fatalities in the accident was a small child.
N, n
N (uppercase) refers to the number of subjects in an entire study. n (lowercase) refers
to the number of subjects in a subgroup within a study.
Examples: The Keokuk County Rural Health Study is a large, prospective and
comprehensive study of households in Keokuk County, Iowa (N = 1,000).
We used responses of female controls (n = 475) from the populationbased Cancer and Steroid Hormone Study.
nation
Because CDC publications often have an international readership, avoid using nation
or this country as a synonym for the United States.
Avoid:
This nation has a vast public health network.
Use:
The United States has a vast public health network.
negative, normal, abnormal
These terms apply to the results of laboratory tests or medical examinations, not to
tests or examinations themselves.
Incorrect:
The throat culture was negative. The patient’s blood test was abnormal.
Correct:
The culture was negative for streptococci. Results of the blood test showed
abnormal levels of iron.
normal, abnormal x-rays
The results of x-rays are normal or abnormal, not the x-rays themselves.
Incorrect:
The x-ray is abnormal.
Correct:
The results of the x-ray are abnormal.
-ology
-ology is a suffix that means “science of” or “study of.” Use terms ending in -ology only
to refer to the discipline or function and not to the subject of the discipline. Avoid, for
example, using pathology to mean pathologic tests or serology to mean serologic tests.
Incorrect:
The pathology should help us understand the virus’s make-up.
Correct:
The pathologic test should help us understand the virus’s make-up.
over, under
These terms can be ambiguous when referring to time spans, ages, or quantities. Do
not use over and under with time spans. Depending on your meaning, use for or for
66
Words
more than instead of over; use less than instead of under.
Ambiguous: They studied the group over 10 years. (Does this mean for 10 years OR
for more than 10 years?)
Clear:
They studied the group for 10 years.
Clear:
They studied the group for more than 10 years.
When referring to age groups, replace over and under with the more precise older than
and younger than.
Avoid:
All of the participants were over 65 years of age.
Use:
All of the participants were older than 65 years of age.
When referring to numbers of persons, things, or groups, replace over and under with
more than and fewer than or less than, whichever is appropriate.
Avoid:
Over 2,000 people attended the conference.
Use:
More than 2,000 people attended the conference.
Pap smear, Pap test
Change Pap smear to Papanicolaou test. If the term is repeated, write it out in full the
first time, put the abbreviation Pap test in parentheses, and use the abbreviation from
then on.
Example:
A Papanicolaou test (Pap test) is an invaluable tool in the fight against
ovarian and vaginal cancer. Every woman should get a Pap test annually.
parameter
This term is often misused. The word has a specific statistical meaning and should not
be used to mean measurement, value, or number. Except when a descriptive quantity
for a statistical population is meant, change parameter to measurement, value, quantity,
variable, or number.
Example:
Sites along the Mississippi River were not included in the analysis because
they were outside the parameters of the study.
pathology
Pathology is the study and description of disease processes, abnormalities, and lesions;
do not use it in place of abnormalities or lesions.
Example:
CDC is sponsoring a workshop on the pathology and emergence of
infectious diseases.
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GRAMMAR AND STYLE
percent, percentage
Use percent only with numbers. Use percentage with nouns.
Examples: Thirty five percent of high school students always wear their seat belts.
A large percentage of the population is allergic to poison ivy.
Note: In graphs that give percentages, the label on the axis should read percent, not
percentage.
person
The plural of person is persons, not people. People refers to a group of persons who share
particular characteristics (the American people).
Example:
The chronic disease prevention guidelines apply to all persons, not just
people from the United States.
positive test results
Be sure to say what you mean because it could be bad news, not good news.
Example:
A positive reaction to the TB skin test usually indicates latent TB
infection.
preventative, preventive
Use preventive.
principal, principle
The adjective principal means “most important,” or “most influential.” The noun
principal refers to a person who has controlling authority or is in a leading position.
The noun principle refers to a basic belief, law or doctrine, or to an assumption.
Examples: The principal cause of mesothelioma, a rare lung cancer, is exposure to
asbestos. (Principal is an adjective.)
The principal is new to this school. (Principal is a noun.)
Stick to your principles. (Principle means beliefs.)
The acceleration principle is a theory in economics. (Principle means a law.)
regime, regimen, regiment
A regime is a form of government. A regimen is a plan to improve and maintain good
health. A regiment is a military unit.
Examples: The ancien régime refers to the political and social system of France
before 1789.
Treatment of diabetes requires a strict regimen that includes a carefully
68
Words
calculated diet, physical activity, blood glucose testing, and multiple daily
insulin injections.
The 65th Infantry Regiment began as a volunteer unit in 1899.
relation, relationship
A relation is an association between two or more items. Reserve the term relationship
to describe a state of affairs among people related to or dealing with one another.
Examples: Numerous studies have established the relation between lung cancer and
exposure to asbestos.
The two health communicators have a good working relationship.
research subjects, control subjects, study participants
Research subjects have the particular characteristic, engage in the particular behavior,
or are exposed to the particular variable (e.g., a certain drug) under study. Research
subjects are recruited, selected, sometimes subjected to experimental conditions, and
observed.
Control subjects are as similar as possible to research subjects except that they do not
have the particular characteristic under study. Control subjects are recruited, selected,
sometimes exposed to a placebo, and observed.
Study participants can be either the research or the control subjects.
respectively
Avoid using respectively to connect components in a sentence; this construction forces
readers to pause and puzzle over which components go together.
Avoid:
The smoking rates for boys, girls, men, and women were 18, 15, 27, and
26%, respectively.
Use:
The smoking rates were 18% for boys, 15% for girls, 27% for men, and
26% for women.
sacrifice
Sacrifice is a euphemism for killing laboratory animals. Use kill or humanely kill.
serum samples
Because serum does not occur in discrete units, a person cannot have more than one;
that is, a patient has serum, not sera, just as one has blood, not bloods. Discrete
69
GRAMMAR AND STYLE
quantities of serum can be collected; refer to these as serum, serum samples, or serum
specimens rather than sera.
Example:
He collected serum samples from hospital staff at risk for hepatitis B.
significant
Because significant has a specific statistical meaning, it should not be used as a synonym
for important. In a nonstatistical context, use another word such as important, substantial,
notable, major, or great. When statistical significance is meant, P values are usually given.
Example:
The mean blood pressure was significantly lowered, with a P value of .05.
since, because
To avoid ambiguities, use since with time frames only (e.g., since 1960), not as a
synonym of because.
Ambiguous: Since they researched that topic, they found out more about it. (Does it
mean, Because they researched the topic? OR Since the time when they
researched that topic?)
t test
The t is lowercase and italicized.
Example:
A paired t-test was used to compare pre-and post-training scores of
immigrant and U.S.-born Asians.
toxic, toxicity, toxin, toxicant
Toxic means “pertaining to or caused by a poison or toxin.” Toxicity means “the quality,
state, or degree of being poisonous.” Toxins are natural poisons (e.g., snake venom).
Toxicants are manufactured poisons (e.g., chemical pesticides).
Examples: All explosives generate toxic fumes when they detonate.
They investigated the extent of exposure and toxicity among users of a
skin lotion containing mercury.
When botulinum spores grow in contaminated foods or inside the digestive
tract of a young child, they can produce a toxin that causes botulism.
A number of toxicants, such as lead and arsenic, were present in the soil.
United States, U.S.
Use United States as a noun. Use U.S. as an adjective.
Examples: In 1999, 46.5 million adults in the United States smoked cigarettes.
In 1999, 46.5 million U.S. adults smoked cigarettes.
70
Words
use, utilize, usage
The verb to use is always preferred. In general, the short form of a word is preferred
over the long form.
versus, vs., v
Both vs. and v are abbreviations for versus, which means “in contrast to.” Use v (without
a period) only in legal citations and italicize the citation (Brown v Board of Education).
Avoid using versus in comparisons.
Avoid:
The women’s response rate (82%) was high versus the men’s response rate
(34%).
Use:
The women’s response rate (82%) was much higher than the men’s
response rate (34%).
vicious circle, vicious cycle
Vicious circle is the correct term, not vicious cycle.
Website, World Wide Web, the Web
A website is a particular location on the World Wide Web. World Wide Web is
synonymous with the Web. However, capitalize World Wide Web and the Web.
71
GRAMMAR AND STYLE
Tip: Word Use
Strunk’s Advice on Word Use
■
■
■
■
■
■
■
Prefer the familiar word to the ‘hifalutin.
Prefer the single word to the circumlocution.
Prefer the short word to the long.
Prefer the standard to the offbeat.
Prefer the specific to the general.
Prefer the definite to the vague.
Prefer the concrete to the abstract.
Vocabulary Issues
Buzz Words (Fillers)
You can often omit these words without changing the meaning of the sentence.
Leaving them out will make the sentence clearer. Follow Mark Twain’s advice:
“As to the adjective, when in doubt, strike it out.”
Following is a list of fillers to avoid.
a total of
as a matter of fact
current
existing
for all intents and purposes
I believe that
in the end
I would like to point out
last but not least
of course
significant
very
absolutely
basically
definitely
extremely
good
important
it is important that
I would like to say
major
quite
the fact of the matter is that
actually
completely
each and every one of
fine
great
in due course
it should be noted
I would like to stress
obviously
really
the month of
Incomparables
Tip: Top 10 Jargon Words
Jargon
as well as
currently
emphasize
in addition to
in order to
in the vicinity of
large number of
the majority of
utilize
72
Alternative
and, also
now
stress
and, also
to
near
many (or say how many)
most
use
Incomparables such as perfect are absolute and therefore cannot be qualified or
modified. You can say almost or nearly perfect but not more perfect.
Following is a list of incomparables.
absolute
eternal
lethal
terminal
best
fatal
perfect
total
complete
final
square
unanimous
equal
least
supreme
worse
Words
Jargon
Simple, plain English words are always preferable to complicated ones. As Francis de
Sales said, “There is no artifice as good and desirable as simplicity.”
Following is a list of jargon words and their alternatives.
Avoid
A
a considerable amount
a considerable number
accomplish
accordingly
accumulate
acquire
activate
adequate number of
adjacent to
advantageous
afford the opportunity
allocate
along the lines of
ameliorate
an estimated
as a consequence of
as a result of the fact that
as long as
as regards
as well as
at all times
at an early date
at the moment
at the present time
at the time that
attain
augment
Prefer
Avoid
Prefer
much
B
by means of
by
many
do, achieve
so
gather
get
begin, start
enough
next to, near
useful, helpful
allow
give
like, as in
improve
about
C
close proximity
commence
completion
comply with
components
conceal
concerning
construct
contrary to
cumulative
currently
customary
near
begin, start
end
follow, obey
parts
hide
about
build
against
added
now
usual
because
because
if, since
about
and, also
always
soon (or say when)
now
now
when
reach
increase
D
depict
demonstrate
desist
despite the fact that
detrimental
disconnect
disseminate
due to the fact that
duplicate
during the course of
during the time that
during which time
show
show, prove
stop
although, though
harmful
cut off, unplug
send, distribute, spread
because
copy
during
while
while
73
GRAMMAR AND STYLE
Avoid
Avoid
E
effect (v)
effectuate
elucidate
employ
endeavor to
enquire
ensuing
equivalent
evaluate
except when
F
facilitate
facility
Prefer
make
bring about, carry out
explain
use
show
affect, influence
carry out, do
nearly always
in some cases (or say how
many)
try
ask
in a timely manner
promptly, soon
following
in addition to
and, also
equal
in advance
before
test
in case of
if
unless
in conjunction with
and, with
in most cases
often, mostly
in order to
to
make easier, ease, help
in reference to
about
building, laboratory,
in spite of the fact that
despite
in terms of
about
office
feasible
possible
in the absence of
without
feedback
comments, response
in the amount of
for
finalize
complete, conclude, finish in the context of
following
after
in the course of
during, while
for the duration of
during, while
in the event of
if
for the purpose of
for
in the near future
soon
for the reason that
because
in the neighborhood of
about, around
formulate
work out, devise
in the vicinity of
near
frequently
often
is in a position to
can
functionality
function
it is clear that
clearly
fundamental
basic
it is incumbent upon us
we must
in view of the fact
as, because
it would appear that
apparently
it is probable that
probably
inception
start
initial
first
input
comment
inquire
ask
institute (v)
begin, set up, start
G
give rise to
74
I
illustrate
impact (v)
implement
in almost all instances
in a number of cases
Prefer
cause
in
Words
Avoid
Prefer
L
large number of
linkage
listing
location, locality
P
many (or say how many) paradigm
link
parameter
list
partially
place
permit
pertaining to
place (v)
portion
size
predominant
way
preparatory to
make
presently
occur, happen, appear
previous to
methods, procedure
prioritize
moderate, ease, soften,
procure
relieve, reduce
prolonged
besides, also, and
provided that
purchase
require, need
but, however
R
unable
regarding
regulation
remainder
represents
aim, goal
request (v)
see
require
get
reside
regularly
residence
for
retain
often
if
because
S
when, if
solely
by
state (v)
use
statutory
working, active, running strategize
or
subsequently
product
subsequent
subsequent to
M
magnitude
manner
manufacture
materialize
methodology
mitigate
moreover
N
necessitate
nevertheless
not in a position to
O
objective
observe
obtain
on a regular basis
on behalf of
on numerous occasions
on the condition that
on the grounds that
on the occasion that
on the part of
operate
operational
otherwise
output
Avoid
Prefer
pattern, example
boundary, limit, extent
partly
let
about
put
part
main
before
soon, shortly
before
rank
get, obtain
long
if
buy
about, on
rule
rest
is
ask
need
live, stay
home, house
keep
only
say
legal, by law
plan
later
next
after
75
GRAMMAR AND STYLE
Avoid
Prefer
Avoid
Prefer
substantial
big
unoccupied
empty
substantiate
prove
until such time
until
sufficient
enough
upon
on
utilization
use
utilize
use
T
take into consideration
terminate
the majority of
thereafter
through the use of
transmit
transpire
consider
end, finish, stop
most
then
by, with
V
viable
virtually
visualize
76
almost
see
send
happen, occur, take place W
with regards to
U
ultimate
uniform
possible
last, final
same, similar
about
Words
Tautologies and Redundancies
A tautology is a needless repetition of a word, idea, or statement, such as in “Five
minutes before he died, he was still alive.” Although this is an extreme example that
might never be used, we use many other tautologies without even realizing it. As
Thomas Jefferson said, “The most valuable of talents is that of never using two words
when one will do.” Below is a list of common tautologies and their alternatives.
Superfluous
Correct
Superfluous
Correct
complete
essential
experience
bonus
planning/notice
exist
and, also
(but not both)
ask
assembled
at, about
(but not both)
cooperate together
costs a total of
current status
cooperate
costs
status
D
doctorate degree
doctorate
end result
exactly identical
extremely minimal
each, every
(but not both)
result
identical
minimal
cancel out
basic, fundamental
(but not both)
cancel
C
CD-ROM disk
center around
clearly evident
blue/red/yellow in color
completely destroyed
complete monopoly
consensus of opinion
contributing factor
controversial issue
CD-ROM
center
evident
blue/red/yellow
destroyed
monopoly
consensus
factor
issue
F
few in number
filled to capacity
final outcome
first and foremost
foreign imports
future plans
few
filled
outcome
first
imports
plans
G-H
general public
HIV virus
public
HIV
A
absolutely complete
absolutely essential
actual/past/present experience
added bonus
advance planning/notice
already exist
and also
ask the question
assembled together
at about
B
basic fundamental
E
each and every
I
if and when
if, when
(but not both)
77
GRAMMAR AND STYLE
Superfluous
Correct
Superfluous
Correct
it is clear
it is obvious
(omit)
(omit)
R
repeat again
repeat
S
small in size
square in shape
still remains
sum total
small
square
remains
total
J-L
join together
large in size
join
large
M
mixed together
month of January
more and more often
mixed
January
often
N
new breakthrough
none at all
breakthrough
none
total number
true fact
12 noon/12 midnight
loan
time, period
(but not both)
total
fact
noon, midnight
O
over and over again
overexaggerate
repeatedly
exaggerate
U
unite together
usual habit
unite
habit
history/experience
period, time
(but not both)
now, today
postpone
V
visible to the eye
visible
P
past history/experience
period of time
point in time
postpone until later
78
T
temporary loan
time period
Words
Words Commonly Misspelled
English spelling can be difficult and illogical. Remember George Bernard Shaw’s
explanation of why ghoti is pronounced fish: gh as in rough, o as in women, ti as
in fiction. The following pages contain a list of commonly misspelled words.
Tip: Word 2000 Shortcut
Spell Check
To check spelling and grammar click F7.
Incorrect
Correct
Incorrect
Correct
A
accomodate, acommodate
acumulate
agressive
alright
amuck
auxilliary
accommodate
accumulate
aggressive
all right
amok
auxiliary
excede
existance
eye witness
exceed
existence
eyewitness
B
bacallaureate
barbituates
baccalaureate
barbiturates
F
ficticious
flurescent
fluride
forword
fullfill
fictitious
fluorescent
fluoride
foreword
fulfill
G
gassify
gasify
H
harrass
heigth
hemorhage, hemorrage
hemmoroid
harass
height
hemorrhage
hemorrhoid
I
indispensible
innoculate
interferred
irelevant
indispensable
inoculate
interfered
irrelevant
L
lenghth
likelyhood
liquify
length
likelihood
liquefy
C
catherization
changable
committment, comitment
concensus
correspondance
catheterization
changeable
commitment
consensus
correspondence
D
day-long
dependant (adjective)
diarhea
dietician
dilemna
dispell
disatisfied
daylong
dependent
diarrhea
dietitian
dilemma
dispel
dissatisfied
E
elegible
embarass
exagerate
eligible
embarrass
exaggerate
79
GRAMMAR AND STYLE
Incorrect
Correct
Incorrect
Correct
M
managable
manouver
mispell
manageable
maneuver
misspell
predominately
prefered
procede
predominantly
preferred
proceed
N
nation-wide
nightime
nationwide
nighttime
R
reccur
relevent
rythm
recur
relevant
rhythm
O
ocasion, occassion
occurence, occurrance
ophtalmology
occasion
occurrence
ophthalmology
S
skilful, skillfull
supercede
skillful
supersede
T
threshhold
threshold
U-W
untill
withold
until
withhold
P
paralel, parallell
personel
preceed
precedant
80
parallel
personnel
precede
precedent
6 Tables, Charts, and Graphs
*
“ ”
You can observe
a lot by just watching.
Yogi Berra
This chapter presents the different types of data
graphics or visuals (i.e., tables, charts, and graphs)
and explains which are best suited for the
information you need to convey. A visual can
convey ideas in a way words cannot and visuals
are often the most effective way to display large
sets of numbers or data. An effective visual
combines simplicity of design and complexity
of data.
Example: “Chartjunk”
Above All Else, Show the Data
A visual should focus on the data, not on the
visual itself. Visuals that are too decorative
distract from the main message, which is to
convey data at a glance. Instead of a clean visual,
you end up with “chartjunk.”
Avoid “Chartjunk”
One simple way to avoid “chartjunk” is to eliminate or reduce the clutter
around a visual, such as explicit grids around a table (unnecessary), extra
borders (useless), heavy lines (cumbersome), two- or three-dimensional effects
(deceptive), or color (distracting). This type of visual surplus is
noninformation that should be eliminated through careful editing.
This computer chart violates many
design theories. It is enclosed in a box,
has a grid, has too many vertical
and horizontal lines, and is threedimensional in perspective. The effect
is too busy, and the information is
difficult to read.
* A version of this chapter originally appeared in ATSDR’s VIC Style Guide.
81
VISUAL MEDIA
Example: Redesigned Chart
The Elements of a Visual
Effective visuals convey complex ideas with
simplicity, clarity, and efficiency. To succeed,
visuals should
■ Show the data.
■ Focus the reader’s attention on the meaning
of the data (content), not on the graphic
design itself (format).
■ Avoid distorting the data.
■ Present a lot of information in a small space.
■ Encourage comparisons of the different data.
■ Serve a clear purpose (compare, contrast,
describe, explore).
■ Be accompanied by and closely related to
the text.
Because all the “chartjunk” has
Guidelines for Enhancing Visuals
been eliminated, the effect
is much more sober, and the
chart is actually readable.
82
To be attractive and effective, the visual should
■ Have the proper format and design (e.g., table, pie chart).
■ Have a balanced look and a relevant scale (do not create a visual for a small amount
of data).
■ Be technically and scientifically accurate.
■ Avoid decorations and “chartjunk.”
Tables, Charts, and Graphs
Tables
Definition
Tables are numerical values displayed in rows and columns. They are useful for showing
a large number of data in a small space, either with numbers or words. The purpose of
a table is to present data or information and to support statements in the text. A table
should stand independently, without any explanations from the text.
The Six Elements of a Table
A table typically contains six major elements:
1 Number and title. Each table needs a number and a title that succinctly describes what
the table represents. The title for each table should be unique, brief, and informative.
The title should be in bold to stand out and should not be followed by a period.
2 Column headings. Each column should have a heading that contains the main categories
of information and identifies the entries in the columns. Headings should be brief and
descriptive. Units of measure, where necessary, should be either specified as part of the
heading or enclosed in parentheses under the heading. Column headings are usually in
bold.
3 Row headings (or data stubs). The left-hand vertical column carries a column heading
and lists the items about which information is given in the table.
4 Body (or data field). The body consists of individual cells (data points) and contains the
information or data the author wants to present. These data can be numbers, text, or
symbols.
5 Rules (or lines). Rules separate the table into its various parts. A common mistake in
designing tables is to enclose the information in a grid. Instead of guiding the reader’s
eye through the data, the striped texture of a grid actually fights with the information.
Tables look better if they are not closed on all sides.
83
VISUAL MEDIA
6 Source and footnotes. The source line identifies the origin of the data. When a source
line is needed, it appears below the table and the footnotes. Footnotes explain individual items in the table and minimize the visual clutter of a table. Following are
a few guidelines and tips on how to use footnotes properly.
General Guidelines for Using Footnotes
Tip: Word 2000 Shortcut
■
Inserting Footnote Symbols
Place the cursor where you want to insert the symbol.
1. On your toolbar, click Insert, Symbol to open the Symbols window.
2. Select the Symbols tab. Under Font select (normal text) and under Subset
choose Basic Latin.
3. Scroll down until you find the appropriate symbol.
4. Highlight the symbol and click Insert.
5. Click Close to close the window.
■
■
■
Use abbreviations in the table, and define them
in footnotes.
List the footnotes in the order in which they
appear in the table. Go across rows from left to
right, not across columns from top to bottom.
If a footnote applies to the entire table, put the
footnote symbol after the title.
If a footnote applies to an entire column or row,
place the footnote symbol after the column or
row heading.
Using Footnote Symbols
Tip: Word 2000 Shortcut
Superscripting Symbols
Highlight the symbol, letter, or number you want to superscript.
1. On your toolbar, click Format, Font to open the Font window.
2. Select the Font tab, select Superscript.
3. Click OK.
For 10 footnotes or less, use the following superscript symbols in order:
*
Asterisk
†
Dagger
‡
Double dagger
§
Section mark
¶
Paragraph mark
For footnotes 6 through 10, double the symbols.
For more than 10 footnotes, use superscript lowercase letters (e.g., 152a, 240b) instead of
numbers because numbers could be mistaken for the numerical data within the table.
84
Tables, Charts, and Graphs
Example: Table
Indoor Air Results in Classroom, Offices, and Hallways—
Webster Middle School, Milwaukee, Wisconsin, July 10, 2000
Lowest Level
Detected
Highest Level
Detected
Frequency
of Detection
Comparison
Value
Outdoor Air Levels in
Milwaukee 1996–1998
Toluene
11†
21
5 in 6
420.0‡
0.6–10.6
Total xylenes
7.9
24.5
5 in 6
100.0§
0.7–6.5
Chloroform
ND¶
ND
0 in 6
NA
ND
cis-1,2-dichloroethylene
0.8
8.1
6 in 6
303.3‡
NA
Trans-1,2-dichloroethylene
ND
1.3
1 in 6
597.0‡
NA
1,1-dichloroethylene
ND
ND
0 in 6
0.02**
NA
Methylene chloride
1.0
5.8
6 in 6
3.8**
0.4–1.3
ND
ND
5 in 9
0.1**
ND
Chemical
Petroleum-Based VOCs*
Chlorinated VOCs
Vinyl chloride
* VOCs: Volatile organic compounds.
† All concentrations in micrograms per cubic meter (µg/m3).
‡ EPA’s reference dose.
§ ATSDR’s chronic environmental media evaluation guide.
ND: Not detected.
** Cancer risk evaluation guide for 1 in 1,000,000 excess lifetime cancer risk.
Source: Chemex Laboratories, Milwaukee, Wisconsin, 1998.
85
VISUAL MEDIA
Charts and Graphs
Definition
Charts and graphs represent numerical data in visual form. They show trends, movements, distributions, comparisons, and cycles. The following sections present common
types of charts and graphs.
Example: Bar Chart
Bar Charts
A bar chart is most effective for comparing
amounts, frequencies, sizes, or magnitudes of
several items at one time. Bar charts consist of
horizontal or vertical bars of equal width,
scaled in length to represent some quantity.
Formatting Guidelines for Bar Charts
■
■
■
■
86
Make sure the space between the bars is no
less than half the width of the bar and no
more than twice the width of the bar.
Identify the bars with a key.
Use solid colors instead of patterns on the
bars.
Use contrasting colors for charts that have
more than one series of bars.
Tables, Charts, and Graphs
Pie Charts
Example: Pie Chart
A pie chart presents data as wedge-shaped sections of a circle and shows the relative size of a
whole divided into segments. The circle must
equal 100%, or the whole of some quantity, with
the wedges representing the various ways the
whole is divided. Pie charts are the most easily
understood at one glance.
Formatting Guidelines for Pie Charts
■
■
■
■
■
■
Make sure the wedges together equal 100%.
Begin at the 12 o’clock position, and sequence
the wedges clockwise from the largest to the
smallest.
Restrict the number of wedges to seven. Too
many items make the pie look cluttered and
too few items will not make a useful graph.
Give each wedge a distinctive color, pattern,
shade, or texture.
Keep all callouts (the labels that identify each
wedge) horizontal, and include the percentage
value for each wedge.
Explode one slice to call attention to it.
Example: Flowchart
Flowcharts
A flowchart illustrates, in sequence, the
progressive steps of an operation. Flow
charts allow the reader to identify the essential
steps of the process quickly and easily. Most
flowcharts go from left to right and top to
bottom, but the flow may be different. Remember
that in the strictest environments, each element of
a chart has a specific meaning (e.g., boxes versus circles).
Formatting Guidelines for Flowcharts
■
■
■
■
Arrange the items from left to right or top to bottom.
Use arrows to indicate the direction.
Label or identify all the steps in the process.
Include a key for symbols readers may be unfamiliar with.
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Organization Charts
An organization chart illustrates the hierarchy of an organization, the functions of
each unit or department, and how they interrelate. The title of each organizational
component (e.g., person, office, section, or division) is placed in a separate box, which
is then linked to other boxes appropriate to the organizational relationship.
Formatting Guidelines for Organization Charts
■
■
■
Example: Organization Chart
88
Use a wider organizational block to denote more authority.
Use a heavier line weight on the lines between the organizational blocks than on the
blocks themselves.
Whenever possible, keep organizational blocks of the same authority the same size.
Tables, Charts, and Graphs
Line Graphs
Example: Line Graph
A line graph is most effective for illustrating
trends over time. The line graph shows the
relation between two variables or sets of
numbers by points connected in a continuous
line. The graph can have more than one set of
variables (more than one line), allowing for
comparisons between two sets of statistics for
the same period of time. When creating such a
graph, label each line.
Formatting Guidelines for Line Graphs
■
■
■
■
Indicate the zero point of the graph
(where the two axes intersect).
Divide the vertical and horizontal axis in
equal portions.
Use the minimum number of grid lines so the lines stand out against
the background.
Make all lettering horizontal if possible, except for the vertical axis, which is usually
positioned vertically.
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7 Guidelines for Exhibits, Posters,
and Electronic Presentations*
Different Documents, Different Purposes
A document intended to be presented to a live audience (in the form of an
exhibit, poster, or PowerPoint presentation) differs greatly from a document
intended to be read on paper (such as a fact sheet or a pamphlet). Therefore,
the writing must be different as well. The following table lists the differences
between the two types of documents.
Presentation Graphic
Printed Document
(Exhibit, Poster, PowerPoint)
(Article, Book)
Format
Large size, projected on a
screen or mounted on a wall
Small size
(typically 8 1⁄2" × 11")
Purpose
To support a message
To carry a message
Presentation
Outline of key points
Detailed, informative piece
Reader/Document Ratio
Many readers/one document
One reader/one document
Audience
Reader scans document
Reader reads document
“
Good things, when
short, are twice
as good.
”
Balthasar Gracian
Big, Bold, Simple, and Consistent
Consider the above-mentioned factors when making a presentation graphic.
Above all, use a design that is big, bold, and simple. A presentation graphic is
rarely too big, bold, or simple. Audiences won’t complain about a slide being
too simple, but they will complain about one being too complex and busy.
* A version of this chapter originally appeared in ATSDR’s VIC Style Guide.
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VISUAL MEDIA
Communication Is the Key
Remember that you are the presenter of the message, and the presentation graphics
must support your message, not be your message. Presentation graphics are only tools;
they can greatly enhance your message, but they should not replace it. Following are a
few suggestions to enhance your presentation.
■ Use visuals sparingly. In fact, visualize giving your presentation without the visual
aid. If you can do it, it is a sign that you, and not the slide show, are the master of the
presentation.
■ Build in blank, black slides. This enables you to speak to the audience directly without
your regular slides distracting them.
Reasons for Using the CDC PowerPoint Templates
PowerPoint templates have been developed for use across CDC to project a consistent
image to our many external audiences. These templates are available through the CDC
Identity Management System, at http://intra-apps.cdc.gov/cdcidentity/Login/Home/login.asp.
Regardless of which template you choose, the addition of your text and supporting
images should be the only customization made to these pieces—the designs must
remain constant. If you have any questions about how to use these items, contact your
brand coordinator.
All CDC staff are encouraged to use the templates because the templates:
■ Reinforce the identity of CDC in the minds of the public and distinguish it
from other agencies. Using the templates ensures that the corporate identity
of our agency is presented consistently and persuasively.
■ Are easy and convenient to use. Remember that your goal is to deliver the
presentation, not to spend all your time creating it.
Using the official templates will save you time, ensure your presentation looks
professional, and reinforce the identity of the agency.
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Exhibits, Posters, and Presentations
Creating Successful PowerPoint Presentations
Follow the guidelines below to produce a clean and professional presentation and
to avoid an electronic circus. Most of these guidelines also apply to other types
of presentations.
General Guidelines
Just because the presentation looks splendid on your computer screen at the office does
not guarantee its effectiveness in front of a large audience. You need to rehearse the
presentation, both for timing and delivery, and you must have a back-up plan.
■ Set up prior to audience arrival. Arriving early will give you time to get acquainted with
the facility and the equipment and to set up the material properly. You will also have
time to greet your audience without being distracted by having to set up equipment
at the last minute. You can never be certain that the technology you are using will be
compatible with the resources available to you for the presentation. Checking out
your equipment early can save you some embarrassment.
■ Practice on site. If at all possible, practice your presentation at the actual site. This will
enable you to become comfortable with the equipment and the setting. The best test
for readability is to sit in the last row of the room. If the slide can be read from the
last row, it is well designed.
■ Have a back-up plan. Technology can be tricky. If possible, have handouts to distribute
in case of equipment failure.
Design Guidelines
Resist the temptation to use every tool available in PowerPoint; excessive visual and
auditory elements will distract from the message. The key to a well-designed document
is knowing which elements to include, but also—more importantly —which ones to
exclude. The best, most powerful designs are the simple ones, the ones that use the
minimum number of elements for the maximum effect.
■ Use visuals sparingly. Do not present too many slides. If you have more detailed
support materials, such as tables, include them in a handout. A rule of thumb
is one slide for every two minutes of presentation time.
■ Use a simple layout. Horizontal rules, bullets, icons, clipart, and other visual
markers can be effective when used in moderation. Your layout should focus
on your message. Too many embellishments clutter the slide and distract from
the primary focus of the slide, which is the message.
■ Make slides easy to see. Be sure the text, pictures, and graphs are large enough to be
seen even in the last row of the room. Use a 48-point font for titles and a 36-point
font for body text.
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Text Guidelines
Use words sparingly and leave plenty of white space in the slide. Crowding the slide
with words is distracting to the audience. Your visual aids should support your
presentation, not be your presentation.
■ Present only one message per slide. Presenting more than one key point is distracting.
■ Use titles and headings correctly. Place the title and headings in the same spot on every
slide. Do not put a period at the end of the title because this encourages the reader to
stop reading.
■ Use key words or phrases instead of complete sentences. This will make the message easier
to read and retain.
■ Follow the 6 × 6 rule. Use no more than six lines of text and no more than six words
per line. The slide should have no more than 36 words. The slide should be an
outline of key points that support your message—not the message itself.
■ Avoid data dump in number charts. Use a maximum of 30 numbers per slide. As a rule,
put the complete data in handout form and present only the bottom line information in the slide.
■ Limit typefaces. Use no more than three compatible, simple typefaces; otherwise the
slide will look too busy.
■ Use serif typefaces preferably, such as Times New Roman (serif typefaces have “feet” at the
tops and bottoms of the characters). Use the bold setting to ensure the thin strokes
of the serifs are easily readable. Keep in mind that fancy and unusual typefaces are
much harder to read than simple ones.
■ Use upper and lowercase text. All caps are difficult to read.
■ Use bullets smaller than text height. This will help focus attention on your text. The
bullet is only a marker preceding a line of text; it is not part of the message.
■ Left-justify bullets, dashes, and text. This focuses the attention to the left side of the
slide, at the start of every line of text.
Visual Guidelines
■
■
■
94
Resist the temptation to over design. In the words of architect Mies van der Rohe, “Less is
more.” Apply this motto and you will create a powerful and effective presentation.
Keep the background simple. Do not use patterned backgrounds because they make
the slide harder to read. A background should never interfere with the information
presented on the screen. Use no more than three colors for text—two colors are preferred—or the slide will become too busy and distract the viewer from the message.
Use a strong contrast between background color and text color. This ensures maximum
legibility.
Exhibits, Posters, and Presentations
■
■
■
■
Use artwork with caution. Artwork might be fun and
entertaining, but it is sometimes inappropriate for
professional presentations. Above all, the images
must be relevant to the topic; don’t include them
just because they look pretty.
Limit sound effects and music. Using too many sound
effects or too much music will clutter your
presentation and distract your audience from
hearing your message.
Example: Bad
Limit the number and kinds of transitional effects.
Using too many different transitional effects also
will clutter your presentation and distract the
audience.
Limit the use of animation. Animation displays objects
on your screen one at a time. For example, if you
are using bulleted points, viewers see the first bullet first, then the second, and so on. There are
many choices, but most are inappropriate if you
want to achieve a professional look. Use discretion.
Example: Good
PowerPoint Tricks
Here are a few tricks that will help you navigate
between slides.
■ Know your slide numbers. When you are in slide show
view, you can move to any slide by hitting the slide
number and pressing “Enter.” This is useful, for
example, if you are answering questions and want
to move rapidly to a key slide.
■ Use the “b” key. When you are in slide show view,
you can get a black screen by pressing the “b” key.
This is useful if you want to momentarily stop the
presentation to answer a question. Press the key again to come back to the slide.
■ Have a specific concluding slide. End your presentation with a slide that says Thank You
or one that repeats the title of your presentation. As a safety measure, insert a blank
slide so you don’t mistakenly click out of the slide show.
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Example: Bad
Poster Preparation Tips
Consider the following factors when preparing
information in poster form.
Capture Your Audience’s Attention
Your exhibit needs to catch the attention of people
passing by your booth. You have only a few seconds to
do this, so your exhibit must be bold and designed more
like a billboard than a fact sheet. Design the exhibit to
grab attention at distances up to 10 feet; the narrative
material and tables should be clear and readable at a
minimum distance of 3 feet.
Keep Your Audience’s Interest
Example: Good
96
An effective exhibit is not a report or a journal article
hung on a wall. It should highlight, through visual
display, the major points or components of your topic
so the viewer can readily understand them. Resist the
temptation to reproduce full pages of text. Viewers will
be more intrigued by crisp, terse phrases and bulleted
lists. No one will read full pages of dense text and you
will lose the crucial points of your presentation. Consider
distributing fact sheets or providing copies of materials
to supplement your exhibit.
8 Writing for the Web
“
Everything should be
made as simple as
possible, but not one
Many of the writing principles that govern printed material also apply to
online material. Your writing must be concise, clear, precise, and correct.
However, you need to make some adjustments in your approach and adapt
the document to the unique requirements of the Web.
Most Web users reportedly use the Web to gather information, and they want
the information quickly. To ensure that users get information quickly, follow
these guidelines.
bit simpler.
”
Albert Einstein
Be Brief
Reading text on a screen is more difficult, more tiring, and more tedious than
reading text in a printed format. Because of the computer screen’s low
resolution, a person’s reading rate is greatly reduced. Keep pages and
paragraphs short, and use the active voice. Web documents should be shorter
than their hard-copy counterparts.
Group the Information to Make It Scannable
Most Web users scan the page rather than read word for word. Keep your
document scannable by using titles, headings, and subheadings and by
chunking (grouping) the information in short paragraphs. Whenever possible,
use bulleted lists. Nothing conveys the information better and faster than
bulleted lists.
Be sure to use meaningful headings and subheadings, not catchy, cryptic ones.
Avoid:
Methodology of Research Into Neural Tube Defects in the
Hispanic Community
Avoid:
Nature vs. Nurture—The Impact of Ethnic Beliefs on Children
Use:
Studies Link Neural Tube Birth Defects to Low Folic Acid
Consumption Among Hispanics
Although the first two choices are accurate (and even provocative), they are too
cryptic. The most effective headings do not ask questions—they answer them.
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VISUAL MEDIA
The third option telegraphs the content, linking birth defects to low folic acid
consumption in Hispanics, and requires no supporting information.
Start with the Conclusion
Web users are usually impatient. To grab their attention, you need to present the
conclusion and emphasize the key messages upfront, using the inverted pyramid style.
Example:
Extensive research has found that all women of childbearing age should
take 400 micrograms of folic acid every day before they get pregnant to
significantly reduce the risk of certain birth defects.
This first sentence contains all of the critical information of the article; a reader can
continue reading for more details about how the research was conducted and why folic
acid works.
Be Simple
Avoid blinking icons, moving text, and aggressive colors; they are distracting and may
make your information look unprofessional. Use graphics sparingly because they take a
long time to download. A simple design and layout is better than a complex one.
Readers want clear information fast, not visual noise that takes an eternity to
download.
Be Accurate
Edit the page carefully for content, spelling, and grammar. Make sure that the links are
accurate and active.
Use Consistent Page Design
A site that is easy to understand and navigate must have a consistent look. You can
accomplish this by repeating certain elements throughout the pages. Each page should
have the same look and feel as all the other pages on the site. The following elements
should be repeated on all pages: color scheme, formatting elements, layout, typography
(fonts), illustrations, and navigation buttons.
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Writing for the Web
Tip: Good Web Design
Twelve Tips for a Concise Scannable Web Site
Before completing your Web page or online document, check the following:
1. Purpose and message. Is the purpose achieved? Is the key message clear and presented at the top of the page?
2. Audience. Does the document reach the intended audience? Is appropriate jargon and vocabulary clearly explained?
3. Content. Is the information chunked? Are the titles, headings, and subheadings clear?
4. Organization. Is the page well organized? Is it navigable?
5. Appearance. Is the text easy to read? Is the document scannable?
6. Graphics. Are the graphics relevant? Do they complement the text, not substitute for it? Do the graphics enhance or distract from the message?
Do the graphics have descriptive captions?
7. Speed. Does the document download quickly?
8. Currency. Is the information up-to-date? Is there a mention of when the page was last updated?
9. Reliability. Is the information accurate and reliable? If outside sources are mentioned or linked to, are these credible?
10. Accuracy. Is the document error-free (no grammar mistakes, misspellings, typos, odd breaks)? Do links work correctly?
11. Interaction. Is contact information listed?
12. Section 508 (accessibility). Can individuals with disabilities navigate the site? For more details consult the CDC IT Accessibility page at
http://intranet.cdc.gov/accessibility/section508/default.htm.
Electronic Glossary: How Do You Spell That Word?
The digital age has created enough new jargon to give anyone a headache. While the debate over the spelling
of some Web-related words is now settled (most everyone agrees that Internet and Web are capitalized), it is
still open for other terms (is it online or on-line?). Until dictionaries agree on a standardized spelling, the
following list provides guidance on preferred spelling of computer-related terms at CDC.
INCORRECT
E-mail, E-Mail, email
the internet
the net
off-line
on-line
url
the web
Webmaster, Web master
web site, Website, Web Site
world wide web
CORRECT
e-mail
the Internet
the Net
offline
online
URL
the Web
webmaster
website
World Wide Web
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Help from the Web
For more information, consult the following sites.
Government Websites
Writing for the Web
www.cdc.gov/nccdphp/cdnr/cdnr_sp0104.htm
This page by NCCDPHP gives advice on how to write and edit Web pages.
Writing for Online Reading
www.cdc.gov/od/hissb/docs/uisg-writing1.pdf
This short pdf file gives guidelines and standards for writing CDC documents that will
be put online.
CDC Website Redesign Project
http://intranet.cdc.gov/redesign/default.htm
This website gives information on template design and other issues.
HHS Web Page Guidance
www.hhs.gov/policy/internet/webcust.html
This HHS site provides guidance on creating a customer-oriented Web page.
Methods for Designing Usable Websites
www.usability.gov/methods/collecting_writing.html
This site by the National Cancer Institute elaborates on how to write effectively for
the Web.
Nongovernment Websites
The Web Style Guide
http://info.med.yale.edu/caim/manual/contents.html
This comprehensive style guide by Yale professors Patrick Lynch and Sarah Horton
discusses all aspects of Web design.
Jakob Nielsen’s Website
www.useit.com/
Jakob Nielsen is a renowned expert on Web usability.
100
Writing for the Web
The Sevloid Guide to Web Design
www.sev.com.au/webzone/design.asp
This site lists more than 100 tips and techniques for effective website creation.
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9 CDC-Specific Guidelines
“
He gains everyone’s
approval who mixes
the pleasant with
This chapter addresses CDC guidelines to be followed when mentioning CDC,
its centers, institute, and offices (CIOs), and the Department of Health and
Human Services (HHS). It also takes you through the steps of the clearance
process and provides tips on correspondence.
Attribution to CDC, CIOs, and HHS
To ensure a consistent image and to promote the CDC identity, integrate the
following elements into all CDC documents:
■ Include a standard description of the agency.
■ Reference HHS.
■ Reference CDC properly.
■ Reference CIOs properly.
the useful.
”
Horace
CDC Templates
CDC has developed templates to ensure consistency when communicating
about the agency. The templates are on CDC’s Identity Management System at
http://intra-apps.cdc.gov/cdcidentity/Login/Home/login.asp.
Including the Standard Description of CDC
Insert the following paragraph at the end of every press release.
The Centers for Disease Control and Prevention (CDC) protects
people’s health and safety by preventing and controlling diseases
and injuries; enhances health decisions by providing credible
information on critical health issues; and promotes healthy living
through strong partnerships with local, national, and international
organizations.
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CONTENT, DOCUMENTATION RESOURCES
Insert this message in any other materials as appropriate, including fact sheets and
backgrounders, reports, correspondence, and websites. Tailor the standard language to
reflect the specific health topics addressed in the content.
Example:
The Centers for Disease Control and Prevention (CDC) protects hospital
patients’ health by preventing and controlling disease outbreaks; informs
clinicians about the dangers of antimicrobial resistance and ways to
prevent it; and works in partnership with state and local health
departments and medical associations to promote clinical standards to
prevent antimicrobial resistance.
Referencing CDC
Spell out the agency name the first time, followed by the acronym in parentheses. Use
the acronym thereafter. Do not insert the in front of the acronym. However, using the is
acceptable when referring to data, a product, or program that belongs to CDC. The
possessive form of CDC can be used to convey the same meaning.
Examples: CDC is committed to improving the public’s health and safety.
The CDC Style Guide is a quick and easy reference tool for employees.
CDC’s style guide is a quick and easy reference tool for employees.
Referencing HHS
CDC must acknowledge its relationship to HHS on all documents, even ones
developed for internal distribution. At least one of HHS’s identifiers (either the eagle
logo or the department’s name spelled out) and at least one of CDC’s identifiers (any
treatment of the CDC design element or the agency’s name spelled out) must appear
somewhere on the document.
When referring to HHS, spell out the department the first time, followed by the
acronym HHS (not DHHS) in parentheses. Use the acronym thereafter.
Specific guidelines on how HHS should be included on the cover and attribution pages
of all communication products are found at http://intranet.hhs.gov/read/esguide/.
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CDC-Specific Guidelines
Referencing an Individual Center, Institute, or Office
The public often perceives CIOs as separate from CDC. This confusion primarily stems
from the use of acronyms when referring to the CIOs, without the inclusion of the
acronym CDC. To strengthen CDC’s identity, avoid using acronyms and always connect
the CIO to CDC.
Confusing: According to NCID, the threat of antimicrobial resistance is increasing.
Clear:
CDC’s infectious diseases center announced that the threat of
antimicrobial resistance is increasing.
Where possible, refer to the specific program within the center. Identifying the specific
program is sufficient; it is not necessary to reference the center.
Example:
CDC’s folic acid program seeks to increase consumption of folic acid
among women of childbearing age.
However, when quoting a CIO director in a press release, use the complete name of the
CIO and attribute the CIO as part of CDC.
Example:
“Tomorrow marks the fifth anniversary of the SafeUSA partnership,” said
Dr. Suzanne Binder, Director of CDC’s National Center for Injury
Prevention and Control.
If you use the complete name of the CIO and if it appears multiple times in the
document, spell it out the first time, followed by the acronym in parentheses. Use the
acronym thereafter. However, if you carbon copy a CIO on the original document, spell
out the CIO in the cc: line.
Incorrect:
cc: NCID
Correct:
cc: National Center for Infectious Diseases, CDC
Note: The above rule applies to external documents only. You may use the CIO’s
acronym when it is cc’d on internal documents.
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CONTENT, DOCUMENTATION RESOURCES
Clearance Information
This section addresses the most common clearance processes, including the (1) Executive
Secretariat clearance for correspondence, (2) HHS clearance for communication
contracts, campaigns, and products, and (3) CDC clearance for media relations activities.
For additional information about HHS and CDC clearances, refer to the CDC
Clearance Info page at http://intranet.cdc.gov/od/oc/clearance/, where you can also
download forms.
Executive Secretariat Clearance Process
Any correspondence requiring the signature of the Director or Deputy Directors, CDC;
the Assistant Secretary for Health and Surgeon General, HHS; the Deputy Secretary,
HHS; the Secretary, HHS; or the President of the United States must be reviewed and
cleared by CDC’s Office of the Executive Secretariat.
When CIOs draft response letters or memoranda that have to be signed by any of these
persons, the drafts must be sent back to the Office of the Executive Secretariat within
the following time frames:
Director’s signature
5 days
Deputy Director’s signature 5 days
Secretary’s signature
3 days
If CIOs are asked to reply to the senders directly, they have 5 working days to respond.
CIOs are responsible for obtaining the proper signature(s), dating the response, and
mailing the document. CIOs should then forward a copy of the signed, dated final copy
to the Office of the Executive Secretariat so that the file can be closed.
Also, when CIOs initiate letters or memoranda that have to be signed by the abovementioned persons, these documents must be submitted in draft form (i.e., doublespaced) to the appropriate Executive Secretariat contact person for clearance and
processing. To find your CIO’s contact person, call 404-639-7120. The draft must
contain the proper approvals at the CIO OD level.
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CDC-Specific Guidelines
HHS Clearance Process
All communication campaigns; publications and audiovisual products; and contracts
for communication activities and products must be cleared by HHS’ Office of the
Assistant Secretary for Public Affairs (OASPA) before any products can be developed.
Submit all forms to CDC’s Office of Communication.
HHS usually takes 3 to 4 weeks to respond to a clearance request. Requests involving
sensitive content, expensive products, or large campaigns may take longer. To ensure
adequate time, allow 6 weeks for the clearance process.
Note: HHS will occasionally respond more quickly to a clearance request. However,
requests for rush approval should be limited to public health crises in which a CIO
must produce materials immediately to meet the public’s need for information.
The types of clearance procedures are
1. Communication campaign clearance (HHS Form 524).
2. Communication contract clearance (HHS Form 524).
3. Publications (HHS Form 615) and audiovisual clearance (HHS Form 524a).
A detailed explanation of the clearance process and the clearance forms are available
at http://intranet.cdc.gov/od/oc/clearance/.
Clearance is NOT required for
■ Reprints and minor revisions (e.g., contact names, meeting agendas, and phone
numbers).
■ Individual issues of journals and newsletters. These types of publications only need
to receive clearance once a year. However, send two copies of each issue to OASPA.
CDC’s Media Relations Division Clearance Process
Clear all media requests and all print, electronic, and Internet products developed for
release to the media through the appropriate CIO communications office (assuring
Center Director approval) and through CDC’s Office of Communication Media
Relations Division (MRD). Allow a minimum of 2 weeks for clearance.
Media Requests
Media requests will be directed to MRD, unless the CIO already has an agreed-upon
plan to manage media calls.
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CONTENT, DOCUMENTATION RESOURCES
All media requests for policy explanations, requests regarding high-profile or controversial
issues, or any requests that have potential for national media interest must be coordinated
through MRD. MRD will coordinate these requests with HHS/OASPA, as needed, and
advise CIOs.
CIOs must inform MRD about on-camera media interviews in advance (those not
involving national issues or sensitive areas), and inform MRD regarding media filming
and/or videotaping that is scheduled on-campus. Media requests on subjects not
related to your specific CIO must be referred to MRD.
Media inquiries, events, or initiatives that involve more than one CIO, or go beyond
CDC purview (e.g., another federal agency) must be coordinated by MRD working
closely with the appropriate CIO communication office(s) and OASPA.
No CDC staff should accept an invitation to a press event or press conference without
prior approval by the appropriate CIO communication office and MRD, in
consultation with the HHS press office.
After-hours media inquiries that come to CDC security staff are routed to the MRD
director or designee, who will coordinate as appropriate with HHS and the CIO
communication offices. CIO communications staff should have a system in place for
after-hours contact, preferably beepers and/or on-call press officers.
Media Products
All print, electronic, and Internet products developed for release to the media must be
cleared through the appropriate CIO communications office and MRD. In addition, all
media materials developed by grantees or partners for CDC or including a CDC quote
must be cleared by MRD before release.
All print materials must be formatted according to MRD guidelines and must include
the HHS or CDC logo in the top left corner. A masthead template is available through
CDC’s Identity Management System at http://intra-apps.cdc.gov/cdcidentity/Login/Home/
login.asp.
The CDC Office of Communication’s Health Communication Division coordinates
with CIOs on script development for television and films, including documentaries and
specials. CIOs must keep MRD updated on all television, film, and Internet projects.
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CDC-Specific Guidelines
All CDC-sponsored organized media events, such as press conferences, media
availabilities, and editorial boards, require MRD approval before commitments
are made. MRD will notify HHS/OASPA and will work with them to involve
the Secretary and other HHS and White House officials when appropriate.
Participation by CDC representatives in organized media events sponsored by
other government, private sector, and nonprofit organizations also must be
cleared through MRD, before commitments are made.
Note: According to HHS policy, contractors are not used to promote media
coverage of events or topics (e.g., pitching topics or events to media). Use
OASPA staff, rather than contractors, to produce video news releases.
Working with CDC’s Media Relations Division
CDC’s policy is to provide timely and accurate information so that the public,
Congress, and the news media may assess and understand CDC’s health
information and programs. Bear in mind the following points regarding media
relations activities:
■ Make available final reports, information, and recommendations.
■ Create open, honest communication that is based on sound science and that
conveys accurate information.
■ Do not withhold information solely to protect CDC or the government
from criticism or embarrassment.
■ Release information consistent with the Freedom of Information Act.
■ Base prevention messages on supportable scientific data and sound
behavioral and communication research principles. At all times, maintain
scientifically valid and accurate health messages.
■ Create targeted health messages that are sensitive to language and cultural
differences and community norms.
A final note: Remember to get official clearance on ALL materials before
proceeding through the approval and printing process.
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CONTENT, DOCUMENTATION RESOURCES
Executive Secretariat Correspondence Guidelines
Clarity and brevity are important features of all correspondence documents. Use plain
English and avoid highly technical language or jargon. The policy of the Office of the
Executive Secretariat is to insert two spaces at the end of a sentence. Please adhere to
this rule when submitting correspondence to that office. Following are guidelines from
CDC’s Office of the Executive Secretariat for developing letters, memoranda, and
information alerts and advisories.
Many of these guidelines come from the HHS Executive Secretariat, available at
http://intranet.hhs.gov/read/esguide/msges.html.
Letters Guidelines
In-house Summary Statement
All CIO-originated correspondence must be accompanied by a one-paragraph
justification called an in-house summary statement. The paragraph should include the
following information: subject, purpose, summary, concerns (if any), recommended
actions, contact person, and telephone number. See Appendix A for a sample in-house
summary statement (page 129).
Summary Statement—Secretarial Correspondence
Letters requiring the Secretary’s signature must include a summary statement. The
CIO writes that summary statement and includes it as a cover page to the letter. All
summary statements should serve as stand-alone documents and should not exceed
one page. See Appendix A for a sample summary statement (pages 130–31).
Summary statements should be formatted as follows:
■ Name of correspondent(s).
■ Subject/issues raised by correspondent.
■ Major points in the response.
■ Other pertinent information.
■ Contact person(s).
Salutation
Letters must be properly addressed and include the proper distribution
list information.
110
CDC-Specific Guidelines
The following table presents the correct way to send correspondence to members
of Congress.
Person
Address
Salutation
Senator
(in Washington, D.C.)
The Honorable (full name)
United States Senate
Washington, D.C. 20510
Dear Senator (surname)
Senator
(Local district/office)
The Honorable (full name)
United States Senator
Address
Dear Senator (surname)
Representative
(in Washington, D.C.)
The Honorable (full name)
House of Representatives
Washington, D.C. 20515
Dear Dr./Mr./Ms. (surname)
Note: Do not write
Dear Representative
Representative
(Local district/office)
The Honorable (full name)
Member, U.S. House of
Representatives
Address
Dear Dr./Mr./Ms. (surname)
The complete list of salutations is in the United States Government Printing Office
Style Manual 2000, available at www.access.gpo.gov/styleman/2000/chapter_txt16.html.
Enclosure
Limit the letter to one or two pages. Include any additional information as an
enclosure. If you include an enclosure, insert the word “Enclosure” at the bottom of the
letter (or the word “Attachment” at the bottom of a memorandum) and mention it in the
body of the letter. In addition, add the appropriate heading at the top of the first page
of the enclosure.
111
CONTENT, DOCUMENTATION RESOURCES
Following are examples of heading formats for enclosures. Center and bold
the heading. Centers for Disease Control and Prevention
Response to the Honorable Jack Kingston on
Hepatitis Prevention and Control
Prepared May 2002
OR
Responses to Comments dated 05/15/02
by the Department of Health and Human Services
Draft for National HIV Case Surveillance System Guidelines
Prepared by the Centers for Disease Control and Prevention
May 2002
OR
Influenza Among Travelers on Cruise Ships
Prepared by the Centers for Disease Control and Prevention
May 2002
112
CDC-Specific Guidelines
Copy Notation
Every draft should include a copy notation, introduced by the initials cc and set two
spaces after the signature block. The cc shows all the people who will get a copy of the
letter or memorandum. The cc section also include other information such as file
names and name of preparer.
General Correspondence
cc:
OD
[the Office of the Director always gets a copy]
CDC/W [for congressional correspondence, the Washington Office gets a copy]
FMO
[for congressional correspondence, FMO gets a copy]
NCEH
[CIO preparing the response; e.g., NCID, NIOSH, PHPPO]
CDC ID ES 1234; Doc. Name: pickaname.doc [tracking number provided by the Office of the Executive
Secretariat, document name provided by the CIO]
Prepared by: RJackson, NCEH, (770) 488-7000 [first initial and last name of preparer, no space, CIO, contact
number]
Spelling verifier used by: NSmith 8/12/01 [first initial and last name of person who typed the letter, no space,
date prepared]
Correspondence from Congressional Liaison Office (CLO)
cc:
OD
NCHSTP
CLO/OS
FMO
OPS
CLO/OS No. 123456789
CDC ID 1234; Doc. Name: pickaname.doc
Prepared by: ESeiler, NCHSTP, (404) 639-8008
Spelling verifier used by: NSmith 09/20/2001
113
CONTENT, DOCUMENTATION RESOURCES
The following table offers additional guidelines on drafting letters and general
memoranda.
DOs
DON’Ts
General
Be responsive to correspondents’ concerns.
Put yourself in place of the correspondents.
Would you be satisfied?
Style
Be brief. Keep responses to one page if possible
but not more than two. On rare occasions,
an enclosure may be required.
Use plain English. Keep sentences and
paragraphs short, where possible.
General
Don’t include extra information on a subject
that does not address the correspondents’
concerns.
Style
Don’t include lengthy paragraphs describing
technical matters in great depth.
Use active voice frequently.
Use I when making a personal statement.
Example: I appreciated learning about….
Use the word attachment when attaching
material to a memo and the word enclosure
when enclosing material with the letter.
Spell out the word percent.
Content
In the first sentence, thank correspondents for
providing their views on the subject of inquiry.
In the second sentence, thank them for any
congratulatory or personal statements.
Give the good news, a positive message,
or alternative solution up-front.
Use the response as an opportunity to inform
correspondents about any of the following, if
applicable/relevant:
■ Approved funding increases in a program
of concern.
■ Approved new initiatives.
■ Recent announcements.
■ An upcoming event.
114
Don’t use technical language or jargon
(except when absolutely necessary and only
when fully explained).
Don’t sound defensive.
Don’t overuse passive voice.
Don’t use we when making a personal statement.
Example: We understand that you...
Don’t overuse the word that.
Don’t use the % symbol.
Content
Don’t repeat the entire, lengthy question that
was posed in the incoming letter.
Don’t bury the good news at the end of the
letter.
CDC-Specific Guidelines
DOs
DON’Ts
Format
When referring to a date, use only the number
(e.g., August 12)
Use Times New Roman, font size 12
Format
When referring to a date, don’t use the number
followed by th (e.g., August 12th)
Specific Memoranda Guidelines
The most frequently used types of memoranda are simple action, complex action,
briefing, and information memoranda.
Simple Action Memorandum
Use this memorandum (sometimes referred to as a Decision Memorandum) to obtain
approval to release a report, obtain agreement to issue a housekeeping or noncontroversial regulation, seek a decision on attending a meeting, and more.
This memorandum, addressing a single straightforward issue, should not exceed two
pages. If you need approval to issue a lengthy report, plan, or other document, include
an abbreviated summary and two copies of the report. Submit lengthy relevant
background material, when necessary, in the form of tabbed attachments.
The issue section should contain a concise statement (preferably one sentence or short
paragraph) of the issue or problem. If this memorandum is an invitation, include the
invitation in this section, along with details (e.g., dates, times).
The discussion section should contain pertinent information regarding the origin,
background, and implications of the issue or problem. It should also contain a brief
statement explaining why the Action Requested By date should be met. See Appendix A
for a sample of a simple action memorandum (pages 132–33).
Complex Action Memorandum
Use this memorandum to present an issue that is not straightforward and for which a
variety of alternatives or options need to be presented. The key to this memorandum
is the clear presentation of the issue and background, and the development of options,
with pros and cons for each option presented in bulleted form.
Start at the beginning and state, in context, what needs to be done as well as the
outcome. Present options and pros and cons in a neutral fashion so as not to favor any
one side.
115
CONTENT, DOCUMENTATION RESOURCES
The issue section should contain a concise statement (preferably one sentence or short
paragraph) of the issue(s) or problem(s).
The background section should contain pertinent information regarding the origin,
background, and implications of the issue(s) or problem(s). It should also contain a
brief statement explaining why the Action Requested By date should be met.
In the options and discussion section, each option should be listed clearly and
concisely. Each option should be followed by a discussion that includes information
about who would benefit if the option were chosen, who would be adversely affected,
what would be the anticipated reaction of those affected, and how much the option
will cost in terms of dollars, staff, and administrative responsibilities. Each discussion
should be followed by the pros and cons, in bulleted form.
The recommendation section provides a recommendation regarding the suggested
course of action. When several issues are presented, a recommendation for each set
of options should be made.
The decision section should list each option or recommendation with appropriate
approval/disapproval lines for the addressee's use. See Appendix A for a sample
complex action memorandum (pages 134–35).
116
CDC-Specific Guidelines
The following table offers guidelines on drafting simple action and complex action
memoranda.
DOs
Provide a clear and concise explanation of the issue
requiring a decision (preferably a short paragraph
of the issue/problem).
Provide framework of the decision to be made in the
form of chronological background information.
Provide a minimum of two options.
Include in the options section anticipated reactions
from external groups (e.g., Congress, industry,
states).
Provide a minimum of two pros and cons for each
option. Present the pros and cons in a balanced
fashion.
Provide costs of options if available/applicable.
Provide a date/time frame in which a decision is
required only if a true time constraint exists
(explain in the discussion section).
Make the case for selecting a particular option in
the recommendation section.
DON’Ts
Don’t overwhelm the presentation with details.
Don’t provide an unbalanced set of pros and cons.
Don’t provide a date/time frame unless a true
constraint exists.
Briefing Memorandum
Use a briefing memorandum to brief HHS officials on a public health issue or to
provide information for an upcoming event (e.g., meeting, speech, hearing). These
memos should contain clear and concise information to familiarize HHS officials with
the purpose of the briefing.
The Background section should contain information about the issue at hand. When
appropriate, present questions that may be raised in the Issues of Concern section. The
Discussion section should summarize HHS’ current or previous responses to the issues
addressed in the Background section. When appropriate, provid talking points. See
Appendix A for a sample briefing memorandum (pages 136–40).
Information Memorandum
Use an information memorandum to provide the Secretary with information that the
sender believes the Secretary should have. Limit the memorandum to two pages or less,
divided into two sections (Purpose and Information Text). Add additional information
if it improves the clarity of the document. See Appendix A for samples 1 and 2 of an
information memorandum (pages 141–46).
117
CONTENT, DOCUMENTATION RESOURCES
Information Alert and Information Advisory Guidelines
Information Alert
This document should be submitted to the Secretary only for urgent matters, for
example, when:
■ An important public health or safety problem has been identified.
■ New information has been obtained about a major issue of concern to the Secretary
or the White House.
■ A sensitive press/media story is imminent.
An information alert should only contain a few bullets describing
■ The issue/problem.
■ Why it is critical for the Secretary to have the information now.
■ What the department is doing/planning/proposing to do to address the
issue/problem.
When necessary, provide additional information as an attachment. See Appendix A
for a sample information alert (pages 147).
Information Advisory
Because the Secretary's schedule may preclude face-to-face contact, an information
advisory may be a suitable substitute. Use judgment when preparing an advisory and
make clear why the Secretary needs to have the information. This document should
be prepared for events/situations that could arise in the near-term.
An information advisory should be no longer than two pages and should describe
■ The issue/problem.
■ Some background.
■ What the department is doing/planning/proposing to do to address the
issue/problem.
When necessary, provide additional information as an attachment. See Appendix A
for a sample information advisory (pages 148).
118
CDC-Specific Guidelines
The following table offers guidelines on drafting information alerts and advisories.
DOs
DON’Ts
Use information alerts for urgent matters requiring
the Secretary’s immediate attention.
Don’t use information alerts or advisories when
simple transmission of a document/information
through the Executive Secretary, HHS, is all that is
needed or if a secretarial action memorandum is
more appropriate.
Describe why the information being conveyed
through an information alert is urgent and
what actions you are proposing to address the
issue/problem.
Keep information alerts to a few bulleted points.
Use information advisories to inform the Secretary
about an important matter that does not require
his immediate attention.
Keep information advisories to no more than
two pages using a bulleted format.
Indicate if there is press, congressional,
or White House interest.
Advise the Secretary of any other concern
or controversy surrounding the issue.
Add an attachment when necessary.
Convey information not meeting the criteria for
information alert or advisory to the Executive
Secretary, HHS, using a short cover memorandum.
Don’t use excessively technical language.
Transmitting Other Information
There will be other information that an OPDIV/STAFFDIV may want to provide
to the Secretary’s office that does not meet the criteria for an information alert or
advisory. Such information should be transmitted with a short cover memorandum
to the attention of the Executive Secretariat, HHS, who will then forward it to
appropriate senior officials. The cover memorandum should summarize the nature
of the information provided and the intended audience.
119
10 Reference Style
“
”
The secret to
creativity is knowing
how to hide your
For biomedical and professional journal citations, CDC follows the Uniform
Requirements for Manuscripts Submitted to Biomedical Journals, available at
www.icmje.org/.
sources.
Albert Einstein
When sending a manuscript to a journal, first check the specific journal’s
requirements, because some journals have style guidelines that differ from the
Uniform Requirements.
Referencing in the Text
The Uniform Requirements follows the citation-sequence system. Citations are
in parentheses and are numbered consecutively in text, tables, and figures. Full
references (author, title, etc.) appear at the end of the document.
Guidelines for Referencing in the Text
■
■
■
Number references consecutively in the order in which they are first
mentioned in the text, tables, and figures.
Number references that appear in tables or illustrations consecutively, as
though they were part of the text.
If a document is cited again, use the same initial number (do not assign a
new number to that citation).
Example:
The American and Western Pacific Regions have been certified
free of indigenous wild poliovirus (1). Current challenges to
global polio eradication efforts include ongoing intense
transmission in northern India (2,3), and continued
importations of wild poliovirus into polio-free areas (4–7).
Referencing at the End of the Document
List references in the order in which they appear in the text, tables, and figures.
Abbreviate journal titles according to the National Library of Medicine’s Index
Medicus, available at www.nlm.nih.gov/tsd/serials/lji.html. The list of journals
indexed is at ftp://nlmpubs.nlm.nih.gov/online/journals/ljiweb.pdf.
Following are examples of reference citations. (Some examples come from he
Uniform Requirements.) In the absence of guidelines for some of the
nonstandard communication materials, the citations have been adapted to
mirror Uniform Requirements’ guidelines.
121
CONTENT, DOCUMENTATION RESOURCES
Journal Article
Standard Journal Article
One to Six Authors
Churchill JE, Ashley DL, Kaye WE. Recent chemical exposures and blood volatile
organic compound levels in a large population-based sample. Arch Environ Health
2001;56(2):157–66.
More than Six Authors
Campagna D, Stengel B, Mergier D, Limasset JC, Diebold F, Michard D, et al. Color
vision and occupational toluene exposure. Neurotoxicol Teratol 2001;23(5):473–80.
Organization as Author
The Cardiac Society of Australia and New Zealand. Clinical exercise stress testing.
Safety and performance guidelines. Med J Aust 1996;164:282–4.
No Author Given
Cancer in South Africa [editorial]. S Afr Med J 1994;84:15.
Volume With Supplement
Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung
cancer. Environ Health Perspect 1994;102 Suppl 1:275–82.
Issue With Supplement
Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to breast cancer.
Semin Oncol 1996;23(1 Suppl 2):89–97.
Volume With Part
Ozben T, Nacitarhan S, Tuncer N. Plasma and urine sialic acid in noninsulindependent diabetes mellitus. Ann Clin Biochem 1995;32(Pt 3):303–6.
* Some examples come from the Uniform Requirements.
122
Reference Style
Issue With Part
Poole GH, Mills SM. One hundred consecutive cases of flap lacerations of the leg in
aging patients. N Z Med J 1994;107(986 Pt 1):377–8.
Issue With no Volume
Turan I, Wredmark T, Fellander-Tsai L. Arthroscopic ankle arthrodesis in rheumatoid
arthritis. Clin Orthop 1995;(320):110–4.
No Issue or Volume
Browell DA, Lennard TW. Immunologic status of the cancer patient and the effects of
blood transfusion on antitumor responses. Curr Opin Gen Surg 1993:325–33.
Pagination in Roman Numerals
Fisher GA, Sikic BI. Drug resistance in clinical oncology and hematology. Introduction.
Hematol Oncol Clin North Am 1995;Apr 9(2):xi-xii.
MMWR Article
CDC. Certification of poliomyelitis eradication. The Americas, 1994. MMWR
1994;43:720–2.
Type of Article Indicated as Needed (e.g., Letter, Abstract)
Wassernaar T, Blaser M. Contagion on the Internet [letter]. Emerg Infect Dis
2002;8(3):335–6.
Book and Other Monograph
Personal Author(s)
Bland M. An introduction to medical statistics. 3d ed. Oxford (UK): Oxford University
Press; 2000.
Editor(s), Compiler(s) as Author(s)
Wilson W, Drew L, Henry N, editors. Current diagnosis and treatment of infectious
diseases. New York (NY): Mc Graw-Hill; 2001.
Organization as Author and Publisher
Institute of Medicine (US). Looking at the future of the Medicaid program.
Washington, DC: The Institute; 1992.
123
CONTENT, DOCUMENTATION RESOURCES
Chapter in a Book
Ferguson J. Biological weapons and US law. In: Lederberg J, editor. Biological weapons:
limiting the threat. Cambridge (MA): MIT Press; 1999. p. 81–92.
Conference
Association Publication
ACGIH. Threshold limit values for chemical substances and physical agents and
biological exposure indices. Cincinnati (OH): American Conference of Governmental
Industrial Hygienists; 1991. p. 95–6.
Conference Paper Presented at Meeting
Zarus GM, Nyhan T, Schmidt H, DeVoney D, Gonzalez A. Integrating technologies to
investigate episodic airborne VOC exposures. Presented at: International Society of
Exposure Analysis Annual Meeting; 2001 Nov 4–8, Charleston, SC.
Conference Proceedings
Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology. Proceedings
of the 10th International Congress of EMG and Clinical Neurophysiology; 1995 Oct
15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996.
Conference Paper Published in Proceedings
Bengtsson S, Solheim BG. Enforcement of data protection, privacy and security in
medical informatics. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O, editors.
MEDINFO 92. Proceedings of the 7th World Congress on Medical Informatics; 1992
Sep 6–10; Geneva, Switzerland. Amsterdam: North-Holland; 1992. p. 1561–5.
Other Published Material
Newspaper Article
Terhune C. Smoking costs the nation $157 billion per year, health researchers say. The
Wall Street Journal 2002 Apr 12;Sect. A:3 (col. 5).
Magazine Article
Gibbs N. Making time for a baby. Time 2002 Apr 15;159(5):48–54.
124
Reference Style
Newsletter Article
Chlordimeform cotton tolerances end by December 1990 proposed. Pestic & Tox Chem
News 1988;16(17):27.
Editorial
Baker JC. Hazards of welding [editorial]. Occup Health 1975;39:63–8.
Letter to the Editor
Orr MF. Public health risks of railroad hazardous substance emergency events [letter to
the editor]. J Occup Environ Med 2001;43:738–40.
Audiovisual Material
HIV+/AIDS: the facts and the future [videocassette]. St. Louis (MO): Mosby-Year
Book; 1995.
Map
North Carolina. Tuberculosis rates per 100,000 population, 1990 [demographic map].
Raleigh (NC): North Carolina Dept. of Environment, Health, and Natural Resources,
Div. of Epidemiology; 1991.
Dictionary and Similar References
Stedman's medical dictionary. 26th ed. Baltimore (MD): Williams and Wilkins; 1995.
Apraxia; p. 119–20.
Legal Material
Public Law
Preventive Health Amendments of 1993, Pub. L. No. 103-183, 107 Stat. 2226 (Dec. 14,
1993).
Unenacted Bill
Medical Records Confidentiality Act of 1995, S. 1360, 104th Cong., 1st Sess. (1995).
Code of Federal Regulations
Informed Consent, 42 C.F.R. Sect. 441.257 (1995).
125
CONTENT, DOCUMENTATION RESOURCES
Hearing
Increased drug abuse: the impact on the nation’s emergency rooms. Hearings before
the Subcomm. on Human Resources and Intergovernmental Relations of the House
Comm. on Government Operations, 103rd Cong., 1st Sess. (May 26, 1993).
Congressional Record
Bregan PR. The return of lobotomy and psychosurgery. Congressional Record 1972
Feb 24;118:E1602–12.
Federal Register
Availability of administrative reports of health effects studies. Fed Regist 1993 May
20;58:29413–14.
U.S. Census Data
Bureau of the Census. 1980 census population: characteristics of the population.
Washington, DC: US Department of Commerce; 1982:62–76.
Congressional Testimony
Testimony of Barry L. Johnson, PhD, assistant surgeon general: Hearing before the
Subcomm. on Human Resources and Intergovernmental Relations of the House
Comm. on Government Operations, 103rd Cong., 2nd Sess. (1994).
Electronic Material
Journal Article in Electronic Format
Murray M. Sampling bias in the molecular epidemiology of tuberculosis. Emerg
Infect Dis [serial online] 2002 Apr [cited 2002 Apr 11];8(4):[6 screens]. Available from
URL: www.cdc.gov/ncidod/eid/vol8no4/00-0444.htm.
Internet Document
Newton Bruder M. Choosing a dictionary [online]. 1998. [cited 2002 Apr 11].
Available from URL: www.grammarlady.com/tips.html.
Monograph in Electronic Format
CDI, clinical dermatology illustrated [monograph on CD-ROM]. Reeves JRT,
Maibach H. CMEA Multimedia Group, producers. 2nd ed. Version 2.0. San Diego:
CMEA; 1995.
126
Reference Style
Computer File
Hemodynamics III: the ups and downs of hemodynamics [computer program]. Version 2.2.
Orlando (FL): Computerized Educational Systems; 1993.
CD-ROM
Pen and ink. Amazing facts (Version 3.1). [CD-ROM]. Chicago (IL): Multimedia Productions,
Inc.; 1997.
E-mail Correspondence
Roland B. [email protected]. Citation lecture [e-mail]. 1998 Sept 15.
Newsgroup Correspondence
LeMaster J. [email protected]. POLINEWS: biological weapons. [online newsgroup].
1998 Jan 2. Available from URL: www.onlinenews.com/archives/January/1998/bioweapons.
Unpublished Material
Document
Smith J. Compendium of facts [unpublished]. Washington, DC: US Department of State.
1987.
In Press
Leshner AI. Molecular mechanisms of cocaine addiction. N Engl J Med. In press 1996.
Miscellaneous
Personal Communication
Marsh WJ. US Department of Health and Human Services [personal communication] 2001
Nov 27.
Secondary Source
Moore MB. The geographical reader for the Dixie children. Raleigh (NC): Branson, Farrar
and Company; 1863. p.103. [quoted in Werner EE. In: Reluctant witnesses: children’s voices
from the Civil War. Boulder (CO): Westview Press; 1998. p. 53.]
Press Release
Office of Sen. Jeffords JM. Workers’ Family Protection Act summary and briefing guide [press
release]. Washington, DC; 1991 July 26.
127
Appendix A–Sample Correspondence
In-house Summary Statement
Subject: Invitation to the Secretary to Attend the 2002 Cancer Conference
The National Center for Chronic Disease Prevention and Health Promotion
would like to invite Secretary Tommy G. Thompson to be the plenary speaker
at the 2002 Cancer Conference, to be held in Washington, D.C., on June 11,
2002. The theme of this year’s Conference is “Meeting the Challenges of
Comprehensive Cancer Control” and is co-sponsored by the National Cancer
Institute. Because of the Secretary’s interest in cancer control, his presence
and participation will provide an excellent opportunity to reinforce the
Administration’s commitment to addressing this chronic disease. We
recommend that the Executive Secretariat process this invitation as soon
as possible. Please contact Mr. John Smith at (404) 639-9826 if you have
any questions.
129
APPENDIX AND SOURCES
Summary Statement—Secretarial Correspondence
NAME OF CORRESPONDENT: Representative Henry A. Waxman (D-CA)
SUBJECT/ISSUES RAISED BY CORRESPONDENT:
Congressman Waxman expressed concerns that releasing data from the Vaccine Safety
Datalink (VSD) could jeopardize this important vaccine safety program if it
compromises the willingness of professionals or families to participate.
MAJOR POINTS IN THE RESPONSE:
• The Department recognizes the importance of vaccine safety in facilitating public
acceptance of immunizations.
• The Department will work to see if a data sharing process for the VSD can be
developed that balances the need to protect the confidentiality of patients, as well as
proprietary data, with the principle of openness in research.
OTHER PERTINENT INFORMATION:
None.
CONTACT PERSONS:
Mirtha Beadle, OS/ES, (202) 205-9042
Verla S. Neslund, CDC, (404) 639-7120
130
Appendix A
Secretarial Correspondence
The Honorable Henry A. Waxman
House of Representatives
Washington, D.C. 20515-6143
Dear Mr. Waxman:
Thank you for your letter expressing concerns that releasing data from the Vaccine
Safety Datalink (VSD) project could endanger this important vaccine safety program if
it compromises the willingness of professionals or families to participate. I want to
assure you that the Department of Health and Human Services (HHS) recognizes the
importance of vaccine safety in facilitating public acceptance of immunizations—one
of our most valuable tools in disease control and prevention.
As noted by the Institute of Medicine in its reviews of vaccine safety during the past
decade, large population cohorts like the VSD are essential for scientific studies to
assess potential causal links between vaccine and adverse events. Furthermore, HHS
recognizes that there are many other important collaborations between managed care
and public health organizations and will work to prevent these collaborations from
being jeopardized.
At the heart of the issue is how we can ensure investigations of vaccine safety concerns
in the United States are of the highest scientific caliber and independence so the study
findings will have the maximal credibility to the largest audience. To help attain these
goals, the Department will work to see if a data sharing process for the VSD can be
developed that balances the need to protect the confidentiality of patients, as well as
proprietary data, with the principle of openness in research.
Please call me if you have any further thoughts or questions. I look forward to working
with you on this issue.
Sincerely,
Tommy G. Thompson
131
APPENDIX AND SOURCES
Simple Action Memorandum
TO:
The Secretary
Through: DS _______
COS _______
ES
_______
FROM:
Director
Centers for Disease Control and Prevention
SUBJECT:
West Nile Virus Information for State Governors—ACTION
Action Requested By: July 22, 2002
ISSUE
In follow up to the Acting Principal Deputy Assistant Secretary for Health’s August 23,
2001, briefing for you on the Department of Health and Human Services’ (HHS) West
Nile virus activities, attached for your approval and signature is a letter to State
Governors providing information on HHS and other federal agencies’ support available
to the states to help facilitate a coordinated effort to mitigate the impact of West Nile
virus and other emerging infectious diseases.
DISCUSSION
There has been considerable public and media attention given to the continued
emergence of West Nile virus in the United States. Since its initial recognition in the
Northeast in the late summer of 1999, the virus has spread via migratory birds to 21
states and the District of Columbia, with the most recent identification in areas of the
deep South and upper Midwest. Wherever this mosquito-transmitted virus has been
detected, it has generated concern about its potential for causing significant outbreaks
of human illness. Other concerns include its impact on equine populations and
wildlife ecology, the effectiveness and safety of control measures used to reduce the risk
to communities, and the costs associated with monitoring and control measures.
The federal agency leading the West Nile effort is the Centers for Disease Control and
Prevention (CDC), which is responsible for assisting the states in tracking the virus,
providing public education and control guidelines, and providing laboratory diagnostic
132
Appendix A
training and support. CDC scientists provide technical assistance, and most
states have requested and received financial support from CDC. The National
Institutes of Health is supporting, through universities and the private sector,
research designed to develop effective therapies and a human vaccine for this
and other similar illnesses, while CDC is conducting research on the
effectiveness of control measures and their optimal application. Recently, a
vaccine for West Nile virus was provisionally licensed by the U.S. Department
of Agriculture to protect our valuable equine populations. The vaccine is
already being shipped by the company to affected areas of the eastern United
States. The Environmental Protection Agency regulates pesticides and provides
assistance in ensuring appropriate applications of control measures. The
Department of Interior’s U.S. Geological Survey’s National Wildlife Health
Center in Madison, Wisconsin, supports bird testing throughout the country.
Even though there is intense federal activity and support to address the
introduction of West Nile virus, the major effort for prevention and control
rests at the state and local level. As at the federal level, aspects of West Nile
virus monitoring and control cross agency boundaries within each state, and
coordination at all levels is essential to have maximum effect.
The introduction of West Nile virus into the United States illustrates the
continued threat of infectious diseases, both naturally occurring and
intentional. The key to addressing them is a well-resourced and trained public
health system working in a coordinated fashion combined with cutting-edge
science to combat and control disease.
RECOMMENDATION
That the Secretary sign the attached letter and send to all State Governors.
DECISION
Approved____________ Disapproved____________ Date____________
Julie Louise Gerberding, M.D., M.P.H.
Attachment:
Tab A – Letter to State Governors
133
APPENDIX AND SOURCES
Complex Action Memorandum
TO:
The Secretary
Through: DS _______ (when appropriate)
COS _______
ES
_______
FROM:
Assistant Secretary for Management and Budget
Centers for Disease Control and Prevention
SUBJECT:
How to prepare a complex action memorandum—ACTION
Action Requested By: July 5, 2002
ISSUE
Insert a concise statement (preferably one sentence or short paragraph) of the issue(s)
or problem(s).
FACTS
Insert pertinent information regarding the origin, background, and implications of the
issue(s) or problem(s).
Also insert a brief statement explaining why the “Action Requested By:” date should be
met.
Single-space text, double-space between paragraphs.
OPTIONS AND DISCUSSION
1. OPTION: List each option clearly and concisely.
DISCUSSION: After each option, insert a discussion section that includes
information about who would benefit if the option were chosen, who would
be adversely affected, what would be the anticipated reaction of those
affected, and how much the option will cost in terms of dollars, staff, and
administrative responsibilities.
134
Appendix A
PROS AND CONS: Insert the pros and cons for each option, in bulleted
form.
Pros:
•
•
•
Cons:
•
•
•
2. OPTION:
DISCUSSION:
Pros:
RECOMMENDATION
Provide a recommendation regarding the suggested course of action. When several
issues have been presented, provide a recommendation for each set of options.
DECISION
1. OPTION: List each option or recommendation with appropriate
approval/disapproval lines for the addressee’s use.
Approved____________ Disapproved____________ Date____________
2. OPTION: ___________________________________________________
Approved____________ Disapproved____________ Date____________
(Signing Official’s Name)
2 Attachments:
Tab A – Copy of Report on...
Tab B – Letter to Senator Smith
135
APPENDIX AND SOURCES
Briefing Memorandum
TO:
The Secretary
Through: DS _______
COS _______
ES
_______
FROM:
Acting Principal Deputy Assistant Secretary for Health
SUBJECT:
Vaccine Issues — BRIEFING
TIME:
May 11, 2001, 10:30 – 11:30 a.m.
PLACE:
The Secretary’s Conference Room
PARTICIPANTS
Arthur Lawrence
Martin Myers
David Fleming
Ben Schwartz
Karen Midthun
John La Montagne
Thomas Balbier
William Raub
David Benor
PURPOSE
The purpose of this briefing is to discuss ongoing activities to address two challenges to
our immunization programs—ensuring an adequate supply of important vaccines and
maintaining the public’s trust and confidence in vaccines.
BACKGROUND
Vaccine Supply Issues
There are a number of factors that affect vaccine supply and distribution.
136
Appendix A
1. Influenza Vaccine - The purchase, distribution, and administration of influenza
vaccine are mainly private-sector responsibilities. Since supply is determined by
commercial companies and distribution is not controlled by the government, we remain
potentially vulnerable to shortages or delays in the future.
The United States experienced a delay in the production of the influenza vaccine for
the 2000-2001 influenza season. Some vaccine companies experienced difficulty with
growing a new virus strain. Two of four companies had manufacturing problems; one
of these companies decided not to produce the vaccine. The delay in production of the
vaccine led to subsequent distribution problems; however, a potential vaccine shortage
was averted. TAB A describes actions taken by the Department’s Interagency Vaccine
Groups (IAVG) to help ensure an adequate supply of influenza vaccine for consumers.
Last November, 29 members of Congress asked the General Accounting Office (GAO)
to investigate the actions taken by vaccine suppliers. GAO is expected to publish a
report on its findings in mid-May. The draft GAO report has been circulated for
Departmental comment. On March 7, 2001, Representative Peter DeFazio (Oregon)
introduced a bill, H.R. 910, to amend the Public Health Service (PHS) Act to provide
that the Secretary may undertake the emergency distribution of influenza vaccine
through assumption of title to all influenza vaccines at the original contracted prices.
In addition, on March 8, 2001, Representative Gary Condit (California) proposed
legislation, H.R. 943, to amend the PHS Act to permit the use of appropriated funds to
support limited administrative costs of a distribution system for influenza vaccine.
For the 2001-2002 influenza season, there are currently three vaccine companies
producing influenza vaccine for the U.S. population. In a usual year, 70-76 million
doses of vaccine are distributed. Based on vaccine companies’ estimates in a “best-case
scenario,” the total possible vaccine available for this season may be up to 84 million
doses. However, there is likely to be a substantial amount of vaccine available late
season, resulting in a situation similar to last year.
A “worst-case scenario,” assuming one company does not produce any vaccine, would
result in the availability of approximately 60 million doses. One company is working
under a consent decree and must comply with various regulatory stipulations and
have approved inspections by an independent review group and the Food and Drug
Administration (FDA). Results of these inspections may influence whether the
manufacturer chooses to produce any vaccine at all, and there is a high likelihood
that any vaccine produced would be delayed.
137
APPENDIX AND SOURCES
2. Tetanus Toxoid-Containing Vaccines (DTaP, Td, and DT) - Since 2000, the number
of vaccine companies distributing diphtheria and tetanus toxoids and acellular
pertussis (DTaP) vaccine decreased from four to two vaccine companies. Inventories
have been low; however, as a result of FDA’s approval of a new preservative-free
formulation of Tripedia (one of the two DTaP vaccines in distribution), vaccine
companies should soon be able to increase supply and comply with vaccine demand.
Only one company is distributing all adult Td, pediatric DT, and tetanus toxoid
vaccines. This company is prioritizing distribution to the military, hospitals, and trauma
centers. Vaccine shortages have occurred locally around the country and, in some
circumstances, routine Td boosters recommended every 10 years are being suspended.
It may be 12-18 months before supply can meet demand. TAB B describes actions taken
by the IAVG to address vaccine shortages.
3. Oral Polio - Inactivated polio vaccine is recommended for routine immunization
against polio. However, in the event of a polio outbreak, CDC believes that oral polio
vaccine (OPV) would be the vaccine of choice. Currently, the United States does not
have a stockpile of OPV, which may be needed in response to an imported outbreak.
The only U.S. licensed vaccine company terminated production in 2000. The CDC and
FDA are working with two companies to develop an OPV stockpile.
Public Trust and Confidence in Vaccines
Because immunization coverage levels in the United States are high and disease rates
are low, public attention is shifting from the benefits of vaccines to potential vaccine
risks. Since vaccination is a relatively memorable event, any illness following
immunization may be attributed to the vaccine. A serious illness following
immunization could be either coincidental or, in very rare instances, caused by the
vaccine. The U.S. House of Representatives’ Committee on Government Reform has
held several hearings on the issue of vaccine safety since May 1999. The IAVG has
provided testimony about our vaccine safety system at several of the hearings, most
recently at a hearing, “Autism - Why the Increased Rates? A One Year Update,” on April
25-26, 2001. TAB C delineates actions taken by the IAVG.
ISSUES OF CONCERN (when appropriate)
138
Appendix A
DISCUSSION
Vaccine Supply Issues
Influenza Vaccine
The influenza vaccine companies have stated that they have the production capacity
to equal or exceed last year’s production. However, FDA believes there is uncertainty
that capacity is sufficient in the event that any one company experiences production
difficulties.
CDC has developed a contingency plan (TAB D) for addressing a potential influenza
vaccine shortage or delay.
The Director, CDC, has sent a letter of appreciation to Aventis Pasteur for agreeing to
work with CDC to implement contingency plans in the event of a vaccine shortage
(TAB F).
CDC has requested that States develop contingency plans in the event there is a
shortage of influenza vaccine and has provided written guidelines to assist them in
planning. CDC requested states submit their draft contingency plans by June 2001.
CDC will hold a workshop at the National Immunization Conference in May 2001
to share planning efforts and best practices so that plans can be finalized by August
of this year.
•
•
•
•
Public Trust and Confidence in Vaccines
As part of the IAVG’s Vaccine Safety Implementation Plan, a contract was recently
initiated with the Institute of Medicine (IOM) of the National Academy of Sciences
to establish an Immunization Safety Review Committee for a period of 3 years.
During this first year of reviews, the committee will look into allegations of potential
links between autism and vaccines, thimerosal-containing vaccines and
developmental disorders, and the harmful effects, if any, of receiving multiple
vaccines simultaneously. The IAVG will monitor the IOM’s reviews for appropriate
action. A copy of the IOM’s first report examining alleged linkages between measlesmumps-rubella vaccine and autism is provided in TAB E.
CDC is funding the establishment of new Clinical Immunization Safety Assessment
Centers to improve scientific understanding of vaccine safety issues at the individual
patient level. Such studies may provide insight into the pathogenesis and risk factors
of adverse vaccine reactions.
FDA continues numerous actions to assure the safety and purity of vaccines, many in
collaboration with the IAVG. These include research and standards to reduce or
remove the potential risk from any unintended presence of viruses or other
impurities, including removal and reduction of unneeded or potentially harmful
•
•
•
139
APPENDIX AND SOURCES
additives (e.g., mercury as thimerosal), and facilitating development of newer, more
highly purified types of vaccines (e.g., purified or recombinant protein and DNA
vaccines).
TALKING POINTS (when appropriate)
Arthur J. Lawrence, Ph.D.
Assistant Surgeon General
6 Attachments:
Tab A - Influenza Vaccine
Tab B - Tetanus Toxoid-Containing Vaccines
Tab C - Public Trust
Tab D - Vaccine Contingency Plan
Tab E - IOM Report
Tab F - Letter to Aventis Pasteur
140
Appendix A
Information Memorandum—Sample 1
TO:
The Secretary
Through: DS _______
COS _______
ES
_______
FROM:
Director
Centers for Disease Control and Prevention
SUBJECT:
Vaccine Safety Datalink—INFORMATION
PURPOSE
To provide information concerning Representative Don Burton’s (R-IN) plans to
subpoena the Vaccine Safety Datalink (VSD) database and to share a proposal by the
Centers for Disease Control and Prevention’s (CDC) National Immunization Program
(NIP) to protect patient privacy while allowing independent verification of key VSD
study results.
INFORMATION TEXT
The Vaccine Safety Datalink (VSD) was established in 1991 for the scientific study of
the safety of vaccines. It currently includes information on medical events, laboratory
utilization, demographics, and immunization histories on approximately 7.5 million
individuals enrolled at eight health maintenance organizations (HMOs). This database
permits the government to conduct research evaluating suspected side effects after
immunizations in a sufficiently large population. There has been a recent increase in
public interest to access the VSD data. This interest has prompted the VSD HMOs to
seek further assurance from CDC that the privacy and confidentiality of their patients
will be safeguarded.
Data sharing with external researchers has never been done with the VSD files; in fact,
even the participating HMOs have not had access to the complete VSD data file. A staff
person of Representative Dan Burton, Chair, House Government Reform Committee,
has indicated she plans to subpoena this database. The participating HMOs have
written that release of records that would compromise patient confidentiality or
proprietary issues would cause them to withdraw from the VSD project. If this were to
141
APPENDIX AND SOURCES
occur, it would seriously impede the government’s ability to study rare vaccine-related
adverse events (e.g., rotavirus vaccine and intussusception). Additionally, the HMOs have
stated that their ability to collaborate in other public health activities will depend on how
the VSD issue is resolved.
Congressman Burton originally requested files used in an analysis of the relationship
between infant exposure to thimerosal in vaccines and the risk of neurodevelopmental
disorders. His staff person, Ms. Beth Clay, has requested that they be given access to VSD
files so that other researchers may reanalyze the data and determine if their conclusions
match those of CDC. Her initial request has evolved, and she is now requesting all of the
“raw data” from the VSD so that it can be made available to non-VSD researchers. She
has not put this request in writing nor identified to whom the data would ultimately be
provided.
CDC is concerned about the privacy rights of involved patients and the proprietary rights
of participating HMOs. The VSD contains enough detailed and dated information on
each individual that the removal of names and addresses is insufficient to ensure that
individual patients or HMOs would remain unidentified. It is possible to identify many
patients by combining a birth date with the dates on which specific kinds of medical care
are delivered, or by combining current VSD data with other public access data that are
not under the control of CDC or VSD. This becomes problematic for individuals with
rare conditions or those who are prescribed uncommon medications. Identification of
individuals could have major negative consequences to the individuals as well as to the
health plans.
CDC is aware that outside groups have strong scientific and personal interest in the
results of VSD analyses conducted at CDC. When CDC results do not support their own
theories and opinions, the desire to scrutinize what was done and to conduct a reanalysis
is understandable. CDC supports the openness of research and the different perspectives
and insights that can be gained when studies are repeated. However, CDC-supported
data sharing should abide by accepted principles of human subjects research and
scientific standards. CDC is proposing a means to allow some reanalysis be done with
VSD files, and the outline of this proposed system is provided at Tab A.
Julie Louise Gerberding, M.D., M.P.H.
Attachment:
Tab A - Proposal
142
Appendix A
Information Memorandum—Sample 2
TO:
The Assistant Secretary for Health
FROM:
Deputy Director for Science and Public Health
Centers for Disease Control and Prevention
SUBJECT:
Follow-up to January 30, 2002, Briefing on Tobacco-Specific
Nitrosamines in Tobacco from U.S.- and Foreign-Brand Commercial
Cigarettes Purchased Outside the United States—INFORMATION
PURPOSE
To provide answers to questions that were raised at the January 30, 2002, Departmental
briefing regarding the Centers for Disease Control and Preventions (CDC) research on
tobacco-specific nitrosamines (TSNAs) in tobacco from U.S.- and foreign-brand
commercial cigarettes purchased outside the United States.
INFORMATION TEXT
Background:
CDC has completed a study that tested the hypothesis that U.S.-brand cigarettes
purchased internationally have significantly higher TSNA levels than the locally
popular non-U.S.-brand cigarettes purchased in the same country. The study
examined cigarettes from the United States, the ten most populous countries in the
world (in addition to the United States), and three additional countries that were
selected so that each of the six World Health Organization regions were represented by
at least two countries. These countries have a total population of approximately 3.8
billion (approximately 65 percent of the world total) and include an estimated 674
million smokers (approximately 60 percent of all smokers in the world).
Results from the study show that the level of TSNAs in cigarette tobacco vary widely
among brands sold around the world. The TSNA levels were significantly higher in
Marlboros than in the popular non-U.S. brands in 11 of 13 foreign countries studied.
(Marlboros are the world’s top-selling brand of cigarettes and the only transnational
brand that could be purchased in all 13 foreign countries). Variations in TSNA levels
most likely result from differences in tobacco blends and manufacturing processes.
143
APPENDIX AND SOURCES
Specific Issues:
Three key questions were raised at the January 30, 2002, Departmental briefing. A brief
answer to each of these questions is provided below. Additionally, summaries of the
scientific literature in support of these answers are provided in the attachment at Tab
A, which also includes answers to specific questions regarding TSNA. Copies of key
articles that provide additional reviews of scientific issues related to the carcinogens in
tobacco and questions raised at the January 30 Departmental briefing also are provided
at Tab B. In addition, Tab C contains Figure 11, which demonstrates that the induction
of lung tumors in rodents by NNK follows a dose-response relationship across a range
of total doses from approximately 10 mol/kg up to 10,000 mol/kg.
Question 1: What is the dose-response curve for NNK (the TSNA most closely linked
to lung cancer risk) exposure and lung cancer inducement?
Response 1: The rate of induction of lung tumors in rodents by NNK follows a doseresponse relationship across a range of doses from approximately 10 mol/kg up to
10,000 mol/kg.
Question 2: Are the levels of expected NNK exposure from cigarettes sufficient to
saturate metabolic pathways relevant to this curve?
Response 2: No, concentrations of NNK in cigarette smoke would not be anticipated
to saturate metabolic pathways involved in enzyme-mediated detoxication or
bioactivation of NNK. The calculated lifetime NNK dose of a smoker is notably close
to the lowest total dose of NNK shown to induce lung tumors in rats. As is typical of
animal toxicology studies, high doses are employed in order to more rapidly induce
high rates of tumors in a small number of animals. Lung tumor incidence continues to
increase when rats are administered total doses of NNK that are 300-400 fold higher
than the calculated total lifetime dose of NNK experienced by a smoker.
Question 3: If the NNK exposure levels from cigarettes are so much lower than the
levels tested in animal toxicology studies, what is the evidence to suggest that lowering
the level of NNK exposure from cigarettes might potentially reduce lung cancer risks?
Response 3: Compared with smokers, nonsmokers with prolonged exposure to
environmental tobacco smoke (ETS) have 15-20 fold lower levels of exposure to NNK
and proportionally lower but still significantly elevated risks of lung cancer. Thus, if
144
Appendix A
there is a threshold for risk from pulmonary carcinogens in tobacco smoke, it is below
the exposure level of ETS-exposed nonsmokers. NNK is one of the most potent and
highly concentrated of the pulmonary carcinogens in tobacco smoke. However, since
TSNAs (including NNK) are only one of several classes of carcinogenic compounds
found in tobacco and tobacco smoke, the potential magnitude of the impact of
reducing TSNAs alone on overall cancer risk cannot be estimated.
Conclusion:
The 2000 U.S. Surgeon General’s report, Reducing Tobacco Use, stated that
manufactured tobacco products should not be any more harmful than necessary given
available technology. The pattern of results in the recent CDC study indicate that
manufacturers can and do produce cigarettes with lower TSNA levels compared with
leading U.S. brands. Yet, even if manufacturers lower the levels of one group of
carcinogens (such as TSNAs), it does not necessarily mean the cigarettes would be less
toxic overall. Consequently, the only effective way to prevent tobacco-related illness is
never to smoke or to quit smoking.
CDC will publish the results of this important study in the scientific literature and
continue to conduct research on levels of harmful constituents in tobacco products,
on smoke from tobacco products, and on blood and urine specimens from people
who smoke and those exposed to secondhand tobacco smoke. If you have additional
questions, CDC scientists would be happy to discuss the results from their research
with you further or provide additional information from the scientific literature.
Julie Louise Gerberding, M.D., M.P.H.
cc:
Assistant Secretary for Health
3 Attachments:
Tab A - Biological Relevance of Tobacco-Specific Nitrosamines and NNK Exposure
Levels to Lung Cancer in Smokers
Tab B - Selected Research Articles
Hecht SS. Tobacco Smoke Carcinogens and Lung Cancer. Journal of the
National Cancer Institute, 1999;91(14):1194-1210.
Hoffmann D, Hoffmann I, El-Bayoumy K. The Less Harmful Cigarette: A
Controversial Issue. Chemical Research in Toxicology, 2001;14(7):768-790.
145
APPENDIX AND SOURCES
Stellman SD, et al. Smoking and Lung Cancer Risk in American and Japanese
Men: An International Case-Control Study. Cancer Epidemiology, Biomarkers
& Prevention, 2001;10:1193-1199.
Tab C - Figure 11 “Relationship between dose of NNK and lung tumor incidence in
male F-344 rats” from Hecht SS. 1998. Chem Res Toxicol. 11(6):580.
146
Appendix A
Information Alert
DATE: June 21, 2001
SUBJECT/LEAD COMPONENT: Human Plague/CDC
WHY THIS INFORMATION IS CRITICAL NOW: A plague-related die-off of a
prairie dog colony and a suspected fatal case of bubonic plague in a 28-year-old male
have occurred in Colorado Springs, Colorado. The Colorado Springs Gazette reported
on Wednesday, June 20, that health officials are investigating the death of the man who
lived near the prairie dog colony. This incident has also been reported to CNN.
SUMMARY OF ISSUE AND DEPARTMENT RESPONSE/ACTIONS:
• Plague epizootics (i.e., disease in animals) are common in prairie dogs along
•
•
Colorado’s Front Range, and the local health department has taken appropriate
measures to reduce risk of human exposures to this disease.
CDC is collaborating with local and state public health authorities to respond to this
outbreak by providing epidemiologic follow-up and diagnostic assistance for the
suspect human case.
Autopsy samples for the suspect case patient will be sent to CDC in Atlanta for a
pathology analysis; other diagnostic tests are pending.
CONTACT:
Mirtha Beadle, OS/ES, (202) 205-8943
Verla S. Neslund, CDC, (404) 639-7120
147
APPENDIX AND SOURCES
Information Advisory
DATE: March 15, 2002
SUBJECT/LEAD COMPONENT: Attendance of Dr. John Marburger, III at the Centers
for Disease Control and Prevention’s (CDC) Third International Conference on
Emerging Infectious Diseases (ICEID 2002) on March 24–27, 2002.
WHY THIS INFORMATION IS IMPORTANT FOR THE SECRETARY: To ensure that
the Secretary is aware that Dr. John Marburger plans to attend the ICEID 2002
Conference in Atlanta on March 24–27.
SUMMARY OF ISSUE, BACKGROUND, AND DEPARTMENT RESPONSE/ACTIONS:
• CDC invited Dr. John Marburger, III, Director, Office of Science and Technology
Policy, Executive Office of the President, to attend and speak at the ICEID 2002
Conference in March. We understand from discussions with his staff that he plans
to attend the Conference.
CONTACT:
Mirtha Beadle, OS/ES, (202) 205-9042
Verla S. Neslund, CDC, (404) 639-7120
148
“
”
What is conceived
Bibliography
well is expressed
clearly.
Biomedical Style Guides
The AMA Manual of Style: A Guide for Authors and Editors
Iverson C, editor. The American Medical Association manual of style: a guide
for authors and editors. 9th ed. Baltimore (MD): Williams and Wilkins; 1998.
The ASM Style Manual
The American Society for Microbiology. ASM style manual for journals and
books. Washington, DC: American Society for Microbiology; 1991.
Nicolas Boileau
The CBE Manual for Authors, Editors, and Publishers
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publishers. 6th ed. Cambridge (MA): Cambridge University Press; 1994.
Dorland’s Illustrated Medical Dictionary
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Philadelphia (PA): WB Saunders; 2000.
Medical Usage and Abusage
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and Wilkins; 2000.
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for manuscripts submitted to biomedical journals. JAMA 1997 Mar 19;
277(11):927–34.
149
APPENDIX AND SOURCES
General Style Guides
The Chicago Manual of Style
The Chicago manual of style. The essential guide for writers, editors, and publishers.
14th ed. Chicago (IL): University of Chicago Press; 1993.
The Elements of Style
Strunk W Jr., White EB. The elements of style. 4th ed. Boston (MA): Allyn and Bacon;
2000.
The Gregg Reference Manual
Sabin WA. The Gregg reference manual. 9th ed. New York (NY): Glencoe/McGraw Hill;
2000.
Merriam Webster’s Collegiate Dictionary
Merriam Webster's collegiate dictionary. 10th ed. Springfield (MA): Merriam-Webster;
1993.
The United States Government Printing Office Style Manual
The United States government printing office style manual 2000. Washington, DC:
United States Government Printing Office; 2000. Available at
www.access.gpo.gov/styleman/2000/browse-sm-00.html.
Websites
Accessibility
The CDC IT Accessibility
http://intranet.cdc.gov/accessibility/section508/default.htm
SMOG Readability Formula
www.cdc.gov/od/ads/smog.htm
Language and Vocabulary
List of Race and Ethnicity Classification
www.whitehouse.gov/omb/fedreg/ombdir15.html
Yourdictionary.com
www2.yourdictionary.com/index.shtml
150
Bibliography
Reference Citations
Index Medicus
www.nlm.nih.gov/tsd/serials/lji.html
The Uniform Requirements for Manuscripts Submitted to Biomedical Journals
www.icmje.org/
Online Citation Styles
www.bedfordstmartins.com/online/citex.html
Writing and Editing
The CDC Identity Management System
http://intra-apps.cdc.gov/cdcidentity/Login/Home/login.asp
CDC’s Scientific and Technical Information Simply Put
www.cdc.gov/od/oc/simpput.pdf
E-Resources for Copy Editors
www.nyu.edu/classes/copyXediting/eresources.html
The Elements of Style
www.bartleby.com/141/.
Netlink Grammar and Research
www.writecontent.com/Writing_Tools/Editing___Research_Links/editing___
research_links.html#amusements
The Plain English Network’s (PEN) Website
www.plainlanguage.gov
Web Issues
CDC Website Redesign Project
http://intranet.cdc.gov/redesign/default.htm
HHS Web Page Guidance
www.hhs.gov/policy/internet/webcust.html
Jakob Nielsen’s Website
www.useit.com/
151
APPENDIX AND SOURCES
Methods for Designing Usable Websites
www.usability.gov/methods/collecting_writing.html
The Sevloid Guide to Web Design
www.sev.com.au/webzone/design.asp
The Web Style Guide
http://info.med.yale.edu/caim/manual/contents.html
Writing for Online Reading
www.cdc.gov/od/hissb/docs/uisg-writing1.pdf
Writing for the Web
www.cdc.gov/nccdphp/cdnr/cdnr_sp0104.htm
152
Index
A
Abbreviations
17–20
Academic Degrees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Addresses and U.S. States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Journal Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Scientific Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Titles of Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
U.S. States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
21–22
Acronyms
CDC Centers, Institute, and Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Use of the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5
Active Voice
11
Antecedents
37–38
Apostrophes
Possessive Nouns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37–38
Plural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
103–105
Attributions to CDC, CIOs, and HHS
B
Bibliography
Brackets
Buzz Words (Fillers)
149–152
38
72
C
Capitalization
23–27
Bulleted Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Compass Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Cross-references in Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Diseases and Microorganisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
153
APPENDIX AND SOURCES
24
25
25
25
26
26
26
26
86
Charts and Graphs
Bar Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Flowcharts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Line Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Organization Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Pie Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
106–109
Clearance
CDC’s Media Relations Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107–109
Executive Secretariat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
HHS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
38–39
Colons
Emphasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Quotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Such as . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Verbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
39–42
Commas
Adjectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Age, Degrees, and Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Attribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Conjunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Contrasting Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Dates and Locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Direct Quotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Independent Clauses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Introductory Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Large Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Nonrestrictive Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Series and Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
First Word of a Quotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geographic Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Government Agencies, Businesses, and Other Institutions . . . . . . . . . . . . . . . . . .
Proprietary Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Seasons and Holidays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sociocultural Derivatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Titles of Books, Essays, Headings, and Conferences . . . . . . . . . . . . . . . . . . . . . .
Titles of Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
154
Index
Correspondence Guidelines
110–119
115–116
Action Memorandum, Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Action Memorandum, Simple . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Briefing Memorandum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Copy Notation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Enclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111–112
Information Advisory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Information Advisory Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Information Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Information Alert Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Information Memorandum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110–115
Letters Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114–115
Memoranda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115–117
Memoranda Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Other Types of Correspondence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Salutation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110–111
Summary Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
129–148
Correspondence Samples
D
Dashes
42
Em dash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
En dash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
E
Each and Every
Ellipses
Expletives
6
43
3, 7
155
APPENDIX AND SOURCES
H
Hyphens
43–45
Adjectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Adverbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Avoid Ambiguity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Chemical Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Foreign Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Fractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Medical Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Nouns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Prefixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Proper Nouns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Time Periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
I
Imperative
Inclusive Language
7
49–53
Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
General Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Race and Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51–53
Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Sexual Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
72
Incomparables
28
Italics
Legal References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Non-English Words and Phrases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Scientific Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
156
Index
J
Jargon
73–76
L
Letters
110–115
Copy Notations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Enclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Salutations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
M
Memoranda
115–117
Briefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Complex Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115–116
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Simple Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
79–80
Misspelled Words
6
Modifiers
Dangling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Misplaced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Squinting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
N
Numbers
31–36
Decimals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Expressing Forms of Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34–35
Formatting and Style Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35–36
Punctuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Singular and Plural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Spacing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Subject and Verb Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
157
APPENDIX AND SOURCES
Ordinals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Percentages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Spelling out Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Beginning a Sentence, Title, or Heading . . . . . . . . . . . . . . . . . . . . . . . . 32
Combination of Numbers Less Than and Greater Than 10 . . . . . . . . . . . . 31
Common Fractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Consecutive Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
General Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Large and Indefinite Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Units of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Clock Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Compound Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Measurement Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33–34
..
Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Time Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Using Numerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
P
Parallelism
Parentheses
Passive Voice
Periods
Possessives
7
46
5, 8
46
8
Eponyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
General Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
96
Poster Presentations
93
PowerPoint Presentations
Design Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
PowerPoint Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Text Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Visual Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
158
Index
Prepositions at End of Sentence
Pronouns and Antecedents
Punctuation
11
11
37–47
Apostrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37–38
Brackets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Colons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38–39
Commas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39–42
Dashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Ellipses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Hyphens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43–45
Parentheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Quotation Marks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Semicolons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Q
Quotation Marks
46
R
Redundancy
Reference Style
11
121–128
At End of the Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Book and Monograph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123–124
Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Electronic Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126–127
In the Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Journal Article . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122–123
Legal Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125–126
Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127–128
Other Published Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124–125
Unpublished Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
159
APPENDIX AND SOURCES
Referencing
103–105
CDC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Individual Center, Institute, or Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
HHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Standard CDC Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
S
Semicolons
47
Clarify Ambiguities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Independent Clauses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Separate Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
12
Sentence Length
9
Singular and Plural
Non-English Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Subject and Verb Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13
Split Infinitives
103–104
Standard CDC Description
T
Tables
83–85
Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83–84
Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Footnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
77–78
Tautologies and Redundancies
14
That/Which/Who
28
Type Styles
All Caps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Bold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Italics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-29
Underline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
160
Index
V
Visuals
Vocabulary, see under “Words”
81–82
W
Web Writing
97–101
Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100–101, 150–152
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97–98
Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
14
Who/Whom
15
Wordiness
49–80
Words
Buzz Words (Fillers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Commonly Misspelled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79–80
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53–71
Incomparables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Jargon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73–76
Redundancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77–78
Tautologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77–78
161
THE CDC
CORRESPONDENCE
MANUAL
March 2012
The CDC Correspondence Manual is a reference tool designed to help you create letters and memoranda
(memos) that are clear, well written, and formatted according to CDC guidelines. This manual
connects you to free web resources, checklists, and tips to make your writing process easier. We
welcome your input, and will consider it for future editions of the manual. Please share comments or
suggestions with Erika Jermé at [email protected].
Edited by:
Erika Jermé, MScPl
Denise Williams, MBA
Reviewed by:
Ron Campbell, MAIA
Dee Dudley
Stacey Hoffman, MPH
Layout and Design:
Brad Goodwin
Revised 2012
First edition, 2003
Developed by the Office of the Chief of Staff, Division of Executive Secretariat.
TABLE OF CONTENTS
SECTION I: Writing Effectively . . . . . . . . . . . . . . . . . . . . . . . . 9
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
How Can I Write More Clearly? . . . . . . . . . . . . . . . . . . . . . . . . 11
What is Plain Language and Why Should I Use It? . . . . . . . . . . . . . . 11
Where Can I Get Additional Help with My Writing? . . . . . . . . . . . . . 12
Chapter 1: The Elements of Good Writing . . . . . . . . . . . . . . . 13
Assessing Readability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
The Four Rules of Good Writing . . . . . . . . . . . . . . . . . . . . . . . 14
Suggested Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Chapter 2: Writing Clearly . . . . . . . . . . . . . . . . . . . . . . . 17
Use the Active Voice and Avoid the Passive Voice . . . . . . . . . . . . . . . Avoid Expletives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Put Statements in a Positive Form . . . . . . . . . . . . . . . . . . . . . . . Use Verbs and Avoid Nominalization . . . . . . . . . . . . . . . . . . . . . Use Simple Verb Tenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . Use Personal Pronouns and Focus on the Reader . . . . . . . . . . . . . . . Treat One Topic per Paragraph . . . . . . . . . . . . . . . . . . . . . . . . Vary Sentence Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Beware of Wordiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Use Words Consistently . . . . . . . . . . . . . . . . . . . . . . . . . . . . Avoid Jargon, Technical Terms, and Pompous-sounding Words . . . . . . . .
Use Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A Note about Commas . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tautologies and Redundancies . . . . . . . . . . . . . . . . . . . . . . . . .
Beware of “Alphabet Soup” . . . . . . . . . . . . . . . . . . . . . . . . . . Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Web Addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18
18
18
19
19
19
19
20
20
20
20
21
21
21
22
22
22
22
The CDC Correspondence Manual
|5
SECTION II: Writing Letters . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 3: Deciding on the Content . . . . . . . . . . . . . . . . . . 25
Purpose of the Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Audience Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 4: Style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Direct Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Indirect Approach: How to Deliver Bad News . . . . . . . . . . . . . . . . . 28
Chapter 5: Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Personal Pronouns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reader Emphasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contractions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Inclusive Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bad News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Courtesy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Apology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Please and Thank You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
31
32
32
32
32
32
33
Chapter 6: Format . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Features of a Well-designed Document . . . . . . . . . . . . . . . . . . . . 35
Formatting Letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Parts and Features of a Letter . . . . . . . . . . . . . . . . . . . . . . . . . 38
SECTION III: Writing Memos and Other Correspondence . . . . 43
Chapter 7: Memos Sent Within CDC . . . . . . . . . . . . . . . . . 45
Tips for Writing Memos Sent Within CDC . . . . . . . . . . . . . . . . . . 45
Formatting Memos Sent Within CDC . . . . . . . . . . . . . . . . . . . . 46
Chapter 8: Correspondence Sent to HHS . . . . . . . . . . . . . . . 49
Writing Memos Sent to HHS . . . . . . . . . . . . . . . . . . . . . . . . . 49
Formatting Memos Sent to HHS . . . . . . . . . . . . . . . . . . . . . . . 53
Writing Other Correspondence Sent to HHS . . . . . . . . . . . . . . . . . 54
Chapter 9: Guidelines for E-mail . . . . . . . . . . . . . . . . . . . 55
Writing E-mails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Formatting E-mails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sending E-mails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Delaying, Recalling, or Replacing a Message . . . . . . . . . . . . . . . . . 6
| The CDC Correspondence Manual
55
55
55
56
SECTION IV: Appendices and References . . . . . . . . . . . . . . . . 57
Appendix A: One Word or Two? . . . . . . . . . . . . . . . . . . . . 59
Appendix B: Jargon . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Appendix C: Tautologies and Redundancies . . . . . . . . . . . . . . 66
Appendix D: Checklist . . . . . . . . . . . . . . . . . . . . . . . . . 68
Appendix E: Word 2010 Help . . . . . . . . . . . . . . . . . . . . . 69
Setting Margins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inserting a Header into a Document . . . . . . . . . . . . . . . . . . . . . .
Inserting the en or em Dash . . . . . . . . . . . . . . . . . . . . . . . . . .
Spacing between Sentences . . . . . . . . . . . . . . . . . . . . . . . . . . Drafts and Watermarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . Converting a Word 2010 File into a PDF File . . . . . . . . . . . . . . . . . Shortcut Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
69
69
70
70
70
71
Appendix F: Sample Correspondence . . . . . . . . . . . . . . . . . 72
Sample Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sample Transmittal Summary Statement . . . . . . . . . . . . . . . . . . . .
Sample Responsive Summary Statement . . . . . . . . . . . . . . . . . . . .
Sample In-House Summary Statement . . . . . . . . . . . . . . . . . . . . Sample Decision Memo to the Secretary, HHS . . . . . . . . . . . . . . . . Sample Complex Decision Memo to the Secretary, HHS . . . . . . . . . . . Sample HHS/IOS/ES Transmittal Memo . . . . . . . . . . . . . . . . . . . 73
74
75
76
77
79
81
Appendix G: Th
e Executive Secretariat Clearance Process . . . . . . . . . 83
Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Reference Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Useful Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
The CDC Correspondence Manual
|7
SECTION I:
WRITING EFFECTIVELY
Section I discusses the unique features of business
writing. It also presents the elements of good
writing and explains how to write more clearly while
answering the following questions:
-- Why is letter-writing important?
-- How can I write more clearly?
-- What is plain language and why should I use it?
-- Where can I get additional help with my writing?
10
| The CDC Correspondence Manual
INTRODUCTION
W
hy is letter-writing important?
CDC’s Office of the Director
receives between 2,500 and
4,000 letters and e-mails annually from
policy makers, state and local health
departments, partners, researchers,
and ordinary citizens. Events over the
past decade—including the September
11 terrorist attacks, the adoption of
the Affordable Care Act, the SARS
and H1N1 pandemics, and the recent
budget cuts—have increased CDC’s
public profile. As a result, we receive
correspondence from diverse audiences,
often on highly technical issues for
which the science is still evolving and
the political implications are significant.
Letters are often the first line of
contact between our agency and our
constituents, and directly represent the
voice of CDC; therefore, these letters
need to be well written and to accurately
reflect the agency’s mission. In addition,
letters must be responsive to the
concern of the correspondent and be
written in a tone that makes the reader
feel heard.
The individual’s whole
experience is built upon
the plan of his language.
How Can I Write More Clearly?
The scientific and medical topics CDC covers
are often highly technical and complex.
Expressing these concepts in language that is
understood by everyone without sacrificing
accuracy can be particularly difficult.
You can create clear, simple, and accurate
correspondence by applying the concepts of
plain language to your writing.
What is Plain Language
and Why Should I Use It?
The Plain Language Act of 2010 (H.R. 946
[111th]) states that “writing should be clear,
concise, well-organized and [follow] other
best practices appropriate to the subject or
field and intended audience.” For more on
federal plain language standards, visit www.
plainlanguage.gov/.
Writing in plain language means creating a
document that is visually appealing, logically
organized, and understandable the first time
it is read. A plain language document presents
the information in the simplest, clearest way,
and leaves no room for misinterpretation by
the reader.
The CDC Correspondence Manual will help
you meet the federal mandate of plain
language in government writing. You will
learn how to write clear and effective letters
and memos by using the appropriate style,
tone, and format.
- Henri Delacroix
The CDC Correspondence Manual
| 11
Where Can I Get Additional
Help with My Writing?
Other reference tools are available to help you
improve your writing skills. For example, the
Chicago Manual of Style, 16th Edition answers
questions about grammar, style, punctuation,
preferred word usage, and citation styles.
LETTER OR MEMO?
Letters and memos are separate forms of correspondence. They serve different purposes
and should not be used interchangeably. A
letter is formal correspondence sent outside
the agency. A memo is an informal letter distributed within the agency.
WRITING RESOURCES ON THE WEB
• CDC Correspondence Manual: http://intranet.cdc.gov/od/ocs/docs/CDC_Correspondence_Manual.pdf
• The Chicago Manual of Style, 16th Edition: www.chicagomanualofstyle.org/
• Writing User-friendly Documents: www.plainlanguage.gov
• The Elements of Style: www.bartleby.com/141/
• The U.S. Government Printing Office Style Manual: www.gpoaccess.gov/stylemanual/browse.html
12
| The CDC Correspondence Manual
CHAPTER 1: THE ELEMENTS OF GOOD WRITING
W
riting clearly can be
challenging at CDC because
of our need to convey highly
technical information about government
rules and regulations, as well as complex
medical and scientific concepts.
Fortunately, writing clearly is a skill
you can learn through practice and by
following the rules in this chapter.
Words of imagination
should be written in
very plain language;
the more purely
imaginative they are
the more necessary it
is to be plain.
- Samuel Taylor Coleridge
Assessing Readability
Ideally, you should aim your writing for a
reading level of 6th grade or less, although
this level might be hard to achieve. Writing
to this level does not make the reading
simplistic, just refreshingly clear.
To assess the readability of your document,
use the following tests:
• The SMOG readability formula, available
at http://intranet.cdc.gov/od/oads/osi/
hrpo/guides/consent/smog.htm.
• The Flesch-Kincaid Grade Level Index, a
Word 2010 option that automatically
computes the reading level of your
document.
ACTIVATING THE FLESCH-KINCAID
GRADE LEVEL INDEX IN WORD 2010
1. From the Review Button in the top
right side of your toolbar, select
Spelling and Grammar, select Options
and then select Spelling & Grammar.
2. In the section “When correcting
spelling and grammar in Word”
section, check the Show readability
statistics box.
3. Click OK.
4. The readability statistics will show up
automatically after the spell check is
complete.
The CDC Correspondence Manual
| 13
The Four Rules of Good Writing
BE CORRECT
Good writing is error-free and grammatically
and stylistically correct. Incorrect grammar,
confusing punctuation, erratic spelling, and
awkward sentence construction will impede
understanding, slow the reading process,
and make your writing look careless and
unprofessional. For a list of words that convey
proper usage versus common usage, consult the
Chicago Manual of Style, Chapter 5: Grammar
and Usage, www.chicagomanualofstyle.org/16/
ch05/ch05_sec220.html. You may also consult
the “One word or two?” list in Appendix A for
more commonly misspelled words.
BE PRECISE
Good writing is also precise and accurate. Using
the correct words is especially important in
the medical and scientific arenas. Your words
can leave no room for error, ambiguity, or
misinterpretation. Be sure to use the right word
every time. Many of the challenges writers
and editors experience relate to usage—or
14
| The CDC Correspondence Manual
the collective habits of a language’s native
speakers. For a list of commonly misused
words, consult the Chicago Manual of Style,
Chapter 5: Grammar and Usage, www.
chicagomanualofstyle.org/16/ch05/ch05_
sec220.html.
BE CLEAR
Good writing is clear writing. If you want
your message to be understood easily, choose
simple, plain words whenever possible, instead
of complicated ones. For a list of jargon and
preferred alternatives, consult Appendix B.
BE CONCISE
William Strunk, Jr., captured the essence of
good writing when he said, “Vigorous writing
is concise. A sentence should contain no
unnecessary words, a paragraph no unnecessary
sentences, for the same reason that a drawing
should have no unnecessary lines and a machine
no unnecessary parts.” For a list of unnecessary
words and their preferred alternatives, consult
Appendix C.
Suggested Language
The following table lists suggested sentences to use in correspondence.
IF…
THEN WRITE…
This is the opening sentence…
Thank you for your letter regarding…*
This is the opening sentence for a letter sent by a
member of Congress on behalf of a constituent…
Thank you for your letter on behalf of your
constituent, Mr. William Marsh, regarding…
This is the opening sentence for a referral by HHS
Secretary…
On behalf of Secretary [last name], thank you for
your letter regarding…..
This is the closing sentence (use whichever is
appropriate)…
• Please contact [name] if you have any further
questions.
• I look forward to working with you on this issue.
• Please feel free to contact me or my staff if we can
be of further assistance.
The incoming letter was cosigned by more than
one person…
This response is also being sent to the cosigner of
your letter, Dr. [last name].†
The incoming letter requests the answer be mailed
to congressional member’s district office…
A copy of this correspondence is being mailed to
your Washington office.†
*Do not use this opening for a “bad news letter.” See “Indirect approach” (page 28) for more details on how to word the opening.
†
This should be the last sentence in the letter.
The CDC Correspondence Manual
| 15
WRITING TIPS
These tips are adapted from the Elements of Style by Strunk and White and are discussed in further
detail in the next chapter and throughout this manual.
Before You Write
• Analyze your audience.
• Identify your audience’s interests, education level, and other specifics.
While You Write
• Use the active voice whenever possible (I sent the letter, not the letter was sent).
• Avoid expletives (there is, there are, it is).
• Use positive terms and avoid negatives (unable, instead of not able).
• Use verbs instead of nouns (announce, not make an announcement).
• Use simple verb tenses (will help, not will be helping).
• Use personal pronouns (I, you, we).
• Treat one idea per paragraph, and write short paragraphs.
• Vary sentence length to avoid monotony.
• Omit unnecessary words (because, not due to the fact that).
• Be consistent in word use. If you call it a widget once, call it a widget throughout.
• Use simple words (we used, not we utilized), and avoid jargon, archaic words, and buzz words
(aspect, idea, absolutely, very, really).
• Use bulleted or numbered lists.
• Avoid using too many capitals.
After You Write
• Use good design and layout.
• Insert plenty of white space.
16
| The CDC Correspondence Manual
CHAPTER 2: WRITING CLEARLY
Y
our challenge is to write in
simple terms without being
simplistic or sacrificing accuracy.
The following are guidelines to help
you write using plain and accurate
language. For more on plain language,
visit www.plainlanguage.gov.
Take advantage of
every opportunity
to practice your
communication
skills so that when
important occasions
arise, you will have
the gift, the style,
the sharpness, the
clarity, and the
emotions to affect
other people.
- Jim Rohn
Use the Active Voice and
Avoid the Passive Voice
A verb is in the active voice when the
performer of the act is the subject of the
sentence. A verb is in the passive voice
when the performer of the act is the object
of the sentence.
Active voice: The agency is releasing the
report.
Passive voice: The report is being released
by the agency.
As a rule, it is better to use the active voice.
The active voice is more accurate, direct,
precise, and interesting. It is also shorter
and easier to read, and it flows better. The
passive voice is generally more obscure,
vague, and stilted than the active voice.
Ideally, 80 to 90 percent of your sentences
should be in the active voice. The passive
voice is preferred only when:
• The subject is unknown.
Example: A copy was circulated
in the office.
• The subject is irrelevant to the matter
or obvious.
Example: The results are being
analyzed right now.
• The emphasis needs to be on the
object, not the subject.
Example: Polio was eliminated in
the Americas in 1997.
• The subject is better left unspoken.
Example: Errors were made in the
report (you don’t want to name the
person responsible for the errors).
The CDC Correspondence Manual
| 17
Avoid Expletives
The word expletive has a few meanings, and
does not always refer to “bad language.” The
words there is, there are, and it is are also called
expletives. Starting a sentence with an expletive
often results in unnecessary verbiage. To be clear
and concise, avoid using expletives.
Avoid: There is evidence to suggest that stress
causes many health problems.
Use: Evidence suggests that stress causes many
health problems.
Avoid: It is often difficult to find links between
diseases and the environment.
Use: Finding links between diseases and the
environment is often difficult.
Put Statements in a Positive Form
Because people respond better to positive
statements, always accentuate the positive and
avoid negative statements. Bad news, especially,
should be conveyed in a tactful manner. Avoid
words such as not, cannot, not possible, prohibit,
refuse, and deny. If you must use negatives,
introduce them with words such as these:
• Unfortunately…
• We regret that…
• We are sorry…
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| The CDC Correspondence Manual
You can rephrase many negative statements in a
more positive way.
Avoid: We are not able to provide a
response before August.
Acceptable: We are unable to provide a response
before August.
Better: We will release the results in August.
Use Verbs and
Avoid Nominalization
Nominalization is the use of nouns instead
of verbs. Verbs are clearer and denote actions,
whereas nouns derived from verbs are abstract,
vague, and may weaken your point. Nouns
derived from verbs are easy to spot: they usually
end in -ance, -ment, and -ion. The sentence can
often be changed to the verb form of the noun.
Avoid: CDC provided funding for the
expansion of the program.
Use: CDC provided funding to expand the
program.
Avoid: The committee will make a decision on
the matter next week.
Use: The committee will decide on the matter
next week.
Use Simple Verb Tenses
Avoid: After having considered all options
carefully, we have changed the
meeting location.
Acceptable: After considering all options
carefully, we changed the meeting
location.
Better: After careful consideration, we
changed the meeting location.
Use Personal Pronouns
and Focus on the Reader
A letter is a formal, written communication
from one person to another person. Even if you
are writing on behalf of the agency, approach the
writing process as if you personally are writing
the letter to another person. Use this approach
even if your letter is to a group of people. To
achieve this effect, use pronouns (e.g., I, we,
you), which personalize the letter by turning
inanimate objects or anonymous entities into
real people. Address the reader as you, the writer
as I, and the agency as we. Also consider using
the possessive forms of these pronouns (such as
the adjective our).
Avoid: The agency will release the findings on
the website.
Use: We will release the findings on our
website.
Also, try to write from the perspective
of the reader, not yourself.
Writer’s perspective: We have posted the
guidelines on our website.
Reader’s perspective: You can find the
guidelines on our website.
Treat One Topic per Paragraph
If possible, introduce the paragraph with a topic
sentence, which describes what will be said
in the paragraph. In addition, try to compose
short paragraphs. One-sentence paragraphs are
perfectly acceptable. Paragraphs longer than 10
lines are hard to absorb and require more of the
reader’s concentration.
Vary Sentence Length
Try to vary the length of your sentences to help
delineate your ideas and keep your reader’s
interest. Sentences that are all the same length
are monotonous, sentences that are too short
produce a choppy effect, and sentences that are
too long are hard to follow.
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Beware of Wordiness
Use Lists
Effective writing is concise and to the point. Use
the minimum number of words for the maximum
effect. One key is to use strong verbs in the active
voice and to limit your use of nouns, adverbs,
adjectives, and jargon. However, be careful to still
maintain an appropriate tone.
If the letter is lengthy, consider presenting some
of the information in bulleted or numbered lists.
Lists help highlight the information and speed
up the reading process. The following guidelines
will help you maximize the effectiveness of lists.
Weak: It is very important that we consider each
and every alternative.
Better: We must consider all alternatives.
Weak: A considerable number of people are
utilizing the test at this time.
Better: Many people use the test now.
Use Words Consistently
In general, if you refer to something as a widget
the first time, call it a widget all the way through.
This practice will avoid confusion. However,
it does not mean that you should never use
synonyms; just be sure the reader knows that the
two terms refer to the same thing.
Avoid Jargon, Technical Terms, and
Pompous-sounding Words
Simple words are usually preferable to
complicated ones. The key is to adapt your
writing to the reader. Only use jargon if the
reader uses the same jargon and will understand
it. Also, if you need to use technical terms for a
lay audience, be sure to explain the terms. You
can find a list of jargon and alternative words in
Appendix B.
BULLETS OR NUMBERS?
Use numbered lists only if a hierarchy
or steps are involved (e.g., step-by-step
instructions on how to do something).
Otherwise, use bullets.
IF YOU USE BULLETS,
USE THE CORRECT ONES
Use appropriately sized and shaped bullets. If
the bullets are unfamiliar or too big, they will
distract from your content. Also, only use lists
if you have at least two, and preferably three or
more, items.
INTRODUCE THE LIST
AND MAKE IT PARALLEL
An introductory statement should precede a list.
In addition, the listed items must be parallel in
structure, meaning the first item in all the bullets
must be in the same grammatical category.
NOT PARALLEL
A healthy lifestyle includes the following:
• Eating well-balanced meals.
• Avoidance of all sweets.
• Exercise every day.
• Getting plenty of rest.
PARALLEL
A healthy lifestyle includes the following:
• Eat well-balanced meals.
• Avoid all sweets.
• Exercise every day.
• Get plenty of rest.
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PUNCTUATE ACCORDING TO CDC STYLE
How to punctuate lists is largely governed by
convention, not by set rules. Therefore, the
rules vary depending on which manual you
consult. The most important rule is to use sound
judgment and be consistent throughout the
document.
If the introductory statement uses words such as
the following or these, insert a colon at the end of
the statement (see example 1 below); otherwise,
do not use any punctuation (see example 2
below). Capitalize the first word in each bullet,
and insert a period after the last word in each
bullet. However, if each list consists of only one
or two words, consider omitting the periods (see
example 2 below).
Following are two examples
of how to punctuate lists.
EXAMPLE 1
A healthy lifestyle includes the following
behaviors:
•
•
•
•
Eating well-balanced meals.
Avoiding all sweets.
Exercising every day.
Getting plenty of rest.
99Insert a colon after the
introductory expression.
99Capitalize the first word in each list.
99Insert a period at the end of each item.
EXAMPLE 2
A healthy lifestyle includes
•
•
•
•
Eating well
Avoiding sweets
Exercising
Resting
99Do not insert a punctuation
mark after the verb.
A Note about Commas
Many writers have strong feelings about the use
of commas. CDC uses the serial (or Oxford)
comma; that is, when a conjunction separates
the last two items in a series, a comma precedes
the conjunction. The serial comma helps to
ensure clarity.
Example: Risk factors include poor diet,
tobacco use, and high blood pressure.
Tautologies and Redundancies
A tautology is a needless repetition of a word,
idea, or statement, such as in “Five minutes
before he died, he was still alive.” Although
this is an extreme example, we use many other
tautologies without even realizing it. As Thomas
Jefferson said, “The most valuable of talents
is that of never using two words when one
will do.” See the table of tautologies and their
alternatives in Appendix C.
Beware of “Alphabet Soup”
Government prose is rife with acronyms and
abbreviations, and overuse may lead to an
“alphabet soup.” Therefore, use them wisely. The
following two sections provide more information
on acronyms and abbreviations.
ACRONYMS AND
ABBREVIATIONS FINDER
For a list of acronyms and abbreviations,
see www.acronymfinder.com.
The CDC Correspondence Manual
| 21
Acronyms
For clarity, always spell out the term the first
time it appears in a document, followed by
the acronym in parentheses. After that, use the
acronym.
Example: Thank you for your letter to the
Centers for Disease Control and Prevention
(CDC) concerning influenza. Please visit our
website for information and updates on the
disease.
Abbreviations
Use abbreviations sparingly in letters, and insert a
period after most abbreviations.
Example: Prof. Xavier will attend the meeting.
Web Addresses
Start the address with www. Only use the
protocol http:// if there is no www in the address
(in the case of an intranet address, for example).
Do not underline or italicize the address (see
instructions in the box below on how to remove
the hyperlink).
Incorrect:
Consult the CDC website at http://www.cdc.gov.
Correct:
Consult the CDC website at www.cdc.gov.
If possible, keep the address on one line.
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REMOVING THE HYPERLINK
IN WORD 2010
1. Highlight the hyperlinked address.
2. Right-click the mouse.
3. Select Remove hyperlink.
Symbols
Do not use mathematical symbols (+, =, ›, %) in
the body of letters.
Avoid: Approximately 20% of those infected
develop a fever.
Use: Approximately 20 percent of those
infected develop a fever.
SECTION II:
WRITING LETTERS
Section II presents specific guidelines for
crafting letters that will address the needs
of the target audience. It discusses how to
develop the content of the letter and how to use
the appropriate style and tone. This section
also outlines the formatting guidelines for CDC
letters. For a checklist of considerations for
writing a letter, skip to Appendix D.
In this section you will learn how
to decide on the following:
--The content
--The style
--The tone
--The format
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CHAPTER 3: DECIDING ON THE CONTENT
B
efore you start writing the
letter, you need to decide its
purpose (why you are writing it)
and analyze the audience (who your
reader is). Understanding the purpose
and the audience ensures that you
develop adequate, appropriate content.
To effectively
communicate, we
must realize that we
are all different in
the way we perceive
the world and use
the understanding
as a guide to our
communication
with others.
- Anthony Robbins
Purpose of the Letter
Analyzing the purpose of the letter helps
you focus on the issue and identify your key
message, thus ensuring that your message is
on target. Ask yourself, “Why am I writing?”
You may write for these reasons:
• To ask for information
• To convey information
• To answer a query
• To approve or deny a request
• To send a referral to someone
Keep in mind that sometimes you may write
for more than one purpose. In addition,
you need to find out why the correspondent
contacted the agency. Knowing this
information helps ensure that you craft
an appropriate response. Ask yourself,
“What does the correspondent want?” The
correspondent may write for these reasons:
• To send information
• To request information or action
• To invite someone to an event
Audience Analysis
Understanding your reader’s background
helps you write a response that the reader will
understand. It also ensures that your message
will be read in its entirety and interpreted
correctly. Ask yourself, “Who is my
audience?” The reader may be one of these:
• Member of Congress or another
politician
• Member of the public
• Person from another agency
(local, state, or federal)
• Interest or advocacy group
(nonprofit, industry)
The CDC Correspondence Manual
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Knowing the reader’s background and level of
expertise in the subject matter helps you tailor
the language to the audience. For example, if
the reader is a physician, you probably can use
scientific and medical terminology without
having to add lengthy explanations. However, if
the reader is a member of the public, you might
need to use simpler terms and explain unfamiliar
concepts. In general, no matter who your reader
is, it is best to write in plain language.
After you have identified the audience and
decided on the information you want to convey,
you need to present it clearly and accurately. The
next chapters will guide you through the process
of organizing and presenting content.
AS YOU COMPOSE THE LETTER, ASK
YOURSELF THESE QUESTIONS:
• Who is the reader?
• What does the reader need or want?
• Why am I writing this letter?
• What is my key message?
• Am I conveying my message accurately?
• Will the reader immediately understand
my message?
• Can I summarize my point in a few short
and precise sentences?
• Can I express myself more clearly?
• Am I using the right words?
• Have I included all the necessary
elements?
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CHAPTER 4: STYLE
S
tyle refers to the manner in
which writers express themselves
through word choice and
sentence construction. Style is the
individual use of language that makes
the content unique. In essence, style is
concerned with the form rather than
the substance of the message.
To get your message across and
achieve maximum impact, your letter
needs to be clear, concise, and written
in the appropriate style. The style of
the letter depends on the message you
need to convey. Neutral or good news
is generally best delivered directly, and
bad news is best delivered indirectly.
Direct Approach
The direct approach is the most efficient way
to communicate, and this type of letter is the
easiest to write. However, you should only use
the direct approach if you know the reader
will respond well to the letter. If the letter
delivers good news, place the good news in
the opening paragraph.
The direct approach typically contains
the following elements:
1.Opening Paragraph. If the letter presents
very good news, place it here.
2.Main Point of the Letter.
3.Closing Paragraph. If it is a good-news
letter, reiterate the good news here.
Have something to
say and say it as
clearly as you can.
That is the only
secret of style.
- Matthew Arnold
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Following is an example of a
direct-approach letter.
March 1, 2011
Mr. Aaron S. Williams
Director, Peace Corps
Paul D. Coverdell Peace Corps Headquarters
1111 20th Street, NW
Washington, DC 20526
Dear Mr. Williams:
Congratulations on the 50th anniversary
of President Kennedy’s executive order
that created the Peace Corps. To date, over
200,000 volunteers have served in 139
countries, a significant accomplishment.
The Peace Corps and the Centers for Disease
Control and Prevention (CDC) share a
common goal of working to solve global
public health problems. Programs such as
the President’s Emergency Plan for AIDS
Relief (PEPFAR) and the Global Health
Initiative (GHI) illustrate opportunities for
CDC and Peace Corps to collaborate toward
this end. Many of our employees themselves
served as Peace Corps Volunteers, and credit
the experience for sparking their careers in
public health. We recognize the valuable
breadth of experience Returned Peace Corps
Volunteers bring to our organization, and are
proud to actively recruit these individuals.
I applaud the work of the Peace Corps to
promote peace and friendship around the
world, and extend my best wishes for a
memorable anniversary celebration.
Sincerely,
Thomas R. Frieden, MD, MPH
Director, CDC, and
Administrator, Agency for Toxic
Substances and Diseases Registry
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Indirect Approach:
How to Deliver Bad News
The indirect approach is harder to write. Use it
to deliver bad news or if you know the reader
will be hostile or resistant to your message.
Following are three factors to consider when
crafting an indirect-approach letter.
STRESS THE POSITIVE
Stress the positive and avoid using negative
terms, if possible. Many times, you can
rephrase negative statements in positive terms.
Avoid: After reviewing the data on the
potential health threats of the site,
researchers concluded that the site does
not pose a danger to the public.
Use: Researchers have reviewed the data on
the potential health threats of the site.
They have concluded that the site is
safe for public use.
If you must use negative statements, preface
them with words like these:
• Unfortunately…
• We regret that…
• We are sorry…
Avoid: We did not receive your application
before the deadline.
Use: Unfortunately, we did not receive your
application before the deadline.
Better: Unfortunately, we received your
application after the deadline.
USE A BUFFER
Before addressing the main point of your
letter, you need a buffer, a sentence or
paragraph that shows you are sympathetic
to the reader’s cause or request. The buffer
will ease the bad news, add perspective, and
establish goodwill between the writer and the
reader. However, do not bury, hide, or coat the
bad news.
In the buffer, use terms that show you empathize
with the reader’s situation. Using a buffer does
not mean that you necessarily have to agree with
the reader’s view.
Suggested terms include the following:
• I share your concern about…
• I understand that…
• I realize that…
Example: I want to assure you that we have
analyzed all the data in the interim report.
4. MAIN POINT.
This is where you present the bad news in
a courteous, civil manner. If possible, avoid
using negative terms.
CONTENTS OF AN
INDIRECT-APPROACH LETTER
Avoid: At this time, we cannot release an
interim report.
Use: At this time, we are unable to release
an interim report.
The indirect approach model usually
contains the six following elements:
If possible, explain the reason you cannot
fulfill the reader’s request.
1. OPENING PARAGRAPH.
Avoid using the words thank you in the
opening of a bad-news letter.
Avoid: Thank you for your letter complaining
about the interim report.
Use: I appreciate your letter concerning the
interim report.
2. BUFFER.
Show you understand the reader’s perspective.
Example: I share your concern about the
accuracy of the interim report.
3. PROCEDURE.
Show that you have examined all sides. Explain
agency processes, if appropriate.
Example: Because we remain committed
to science-based public health, it would be
premature to release results that have not
been verified through significant research or
evaluation.
5. ACTION (IF APPROPRIATE).
This is where you mention future steps.
Example: We are working to complete
the report as quickly as possible. Once we
receive the needed records, we expect to
publish the final report.
6. CLOSING PARAGRAPH.
Thank the reader for the input.
Example: Thank you for your interest in
this important public health issue. I hope
the enclosed information is useful.
The following table lists the differences between the direct and the indirect approach.
DIRECT APPROACH
INDIRECT APPROACH
The letter is easier to write.
The letter is harder to write.
Use this style to deliver neutral or good news.
Use this style to deliver bad news or to respond to
a criticism or a complaint.
Start with Thank you for your letter concerning…
Start with I appreciate your letter concerning…
Deliver the main point in a direct, straightforward
manner.
Use a buffer before delivering the main point.
In the buffer paragraph, show empathy and
acknowledge the reader’s perspective.
The CDC Correspondence Manual
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Following is an example of an
indirect-approach letter.
Dear Colleague:
Public health has been hit hard as a result of
the recession, and budget cuts are straining
the capacity of health departments across
the country. I know that you are under
tremendous pressure from the cumulative
effect of state budget cuts and that the recent
federal budget cuts further increase that
pressure.
These abrupt cuts force difficult and painful
decisions, and federal reductions could hardly
come at a worse time. Many of you have seen
measurable improvements in health in your
states due to programs that are now being
curtailed or eliminated.
The Centers for Disease Control and
Prevention’s (CDC) fiscal year (FY) 2011
budget was cut $740 million from the
previous year, making this our lowest budget
authority since FY 2003. Congress will
undoubtedly consider significant additional
budget cuts in FY 2012 and FY 2013. It has
been agonizing for me to manage these cuts.
Virtually every CDC-funded program has
been affected, and we are cutting our internal
costs to maximize program support. We are
also seeking ways to maximize our support for
our public health partners in the field.
I look forward to speaking with you soon
about ways we can mitigate the impact of
budget cuts on the public’s health. Thank
you for all of your hard work in meeting our
shared goal of protecting and improving the
nation’s health.
Sincerely,
Thomas R. Frieden, MD, MPH
Director, CDC, and
Administrator, Agency for Toxic
Substances and Disease Registry
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CHAPTER 5: TONE
T
one refers to the particular style
of writing that reflects the writer’s
feelings toward the issue and the
reader. Tone is the way the letter “sounds”
and comes across to the reader.
Tone is an often-neglected but crucial
element of a letter: it is what the reader
responds to first. The tone of the letter
leaves a certain impression of the
agency, and you want that impression
to be positive, regardless of the type of
news you deliver. Remember, how you
say it is as important as what you say.
Correspondence should be polite,
informative, and courteous. It should
never be condescending, rude, or
sarcastic. Government prose has
been criticized for being rigid and
bureaucratic. Your goal is to be
professional without sounding too
formal. Put yourself in the reader’s place:
would you enjoy receiving a stilted letter
that starts with Enclosed herewith, please
find…? However, be careful not to go
to the other extreme; there is a fine line
between approachable and familiar.
Below are a few guidelines to help you
use the right tone.
In a writer there must
always be two people-the
writer and the critic.
- Leo Tolstoy
Personal Pronouns
Use personal pronouns (e.g., I, we, you).
These pronouns personalize the letter by
turning inanimate objects or anonymous
entities (e.g., the agency) into real people
(e.g., I, we). In addition, pronouns save
space and increase reading speed. Refer
to the reader as you, the writer as I, and
the agency as we. Also, consider using the
possessive forms of these pronouns (such as
the adjective our).
Avoid: The agency will investigate the
matter and inform the public about
the findings.
Use: We will investigate the matter
and keep you informed about our
findings.
You can increase the use of personal
pronouns by using the active voice instead
of the passive voice.
Avoid: Information about the condition
can be found on the website.
Use: You can find information about the
condition on our website.
Note: Be careful to avoid overuse of the
personal pronoun “I.”
Reader Emphasis
Write with the reader’s perspective in
mind (instead of your own), and stress the
benefit to the reader. Try to use you more
often than I or we.
Avoid: I will send you the report as soon as
it is available.
Use: You will receive the report as soon
as it is available.
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Contractions
Because they are too familiar, do not use
contractions (use I am instead of I’m, we will
instead of we’ll).
Inclusive Language
A respectful tone is free of biased and
discriminatory language. To ensure the use of
inclusive language, be careful when referring
to gender, age, race, or ethnicity. In addition,
use gender-neutral terminology. See “Bias-Free
Language” (Chicago Manual of Style 5.221–
5.230, www.chicagomanualofstyle.org/16/ch05/
ch05_sec221.html) for more details. In addition,
the federal government uses standard language
to identify racial and ethnic groups (www.
whitehouse.gov/omb/fedreg_1997standards).
Following is a short list of
common gender-neutral terms:
Avoid
Use
chairman,
chairwoman
chair, chairperson
congressman
member of Congress,
representative,
legislator
spokesman,
spokeswoman
spokesperson
Bad News
When delivering bad news, buffer it with a
sentence or paragraph that shows compassion.
For more on this, see “Indirect Approach,” in
Chapter 4.
Courtesy
When answering criticism, resist the temptation
to snap back. Always keep a civil and courteous
tone. Avoid the following terms, which may
come across as impatient, condescending, or
presumptuous:
• As I told you before…
• As you are well aware…
• As you well know…
• I am sure you will agree…
• For your information…
Apology
If you must apologize, do it completely, and do
not blame the correspondent.
Avoid: I apologize for the late response, but
we received your application after the
deadline because you did not include the
correct mailstop.
Use: I apologize for the delay.
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If you want to include an explanation, phrase it
in positive terms.
Example: For a prompt reply, please be sure
to include the mailstop (ex: D-14) in the
address.
In addition, use the active voice and assume
responsibility for your mistakes.
Avoid: An error was made in the calculation.
Use: We made an error in the calculation. We
apologize for any inconvenience this may
have caused.
However, consider using the passive voice to
avoid blaming or embarrassing someone.
Avoid: Because the Board of Directors canceled
the meeting, we could not reach a
consensus.
Use: Because the meeting was canceled, a
consensus could not be reached.
Please and Thank You
Use please and thank you, when appropriate.
However, using thank you in the opening of
a letter is inappropriate when answering a
complaint or writing a “bad news” letter. See
“Indirect Approach,” Chapter 4, for more
details.
Avoid: Thank you for your complaint
concerning the report.
Use: I appreciate your concerns about the
report.
In addition, do not thank someone in
advance for an action that has not yet been
accomplished.
Avoid: Thank you in advance for your help.
Use: I look forward to hearing from you soon.
Thanking someone for a thank you letter may
also pose difficulties.
Avoid: Thank you for your letter thanking me
for speaking at the conference.
Use: I appreciate your letter thanking me for
speaking at the conference.
The CDC Correspondence Manual
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CHAPTER 6: FORMAT
F
ormat refers to the manner in
which the information appears on
the page. Proper formatting makes
the document visually appealing and
easy to read, follow, and understand.
This chapter explains the formatting
guidelines for letters.* Following these
CDC conventions ensures that our
agency’s identity and message are
presented clearly and consistently
throughout our correspondence.
*Formatting varies between letters and memos.
Please consult Chapters 7 and 8 for specific memo
formatting guidelines.
A journalist and an
information architect
face exactly the same
problem – how to give
shape to the pile of
information in front
of you in a way that
will make it easy and
natural for people to
comprehend.
Features of a
Well-designed Document
A well-designed document should:
• Be visually appealing.
• Be clutter-free.
• Highlight the different sections clearly.
• Help readers find critical information
quickly.
• Convey the agency’s role, whether
directly or indirectly.
• Give readers a favorable impression of
the agency.
TO ENHANCE READABILITY
• Write short paragraphs.
• Create plenty of white space (use 1"
margins, start on line 9, insert a blank
line between paragraphs).
• Use bulleted or numbered lists, if
appropriate.
- Jesse James Garrett
The CDC Correspondence Manual
| 35
Formatting Letters
The following table will help you format your letters.
TOPIC
FORMAT
Font
Use Times New Roman, point size 12. If size 12 does not fit, adjust margins
or use size 11.5.
Justification
(Text Alignment)
• Align all text left, except for the signature block, which starts at 3” from
the left margin.
• Do not justify (make straight) the right margin.
Line Spacing
• Draft: double space the lines.
• Final: single space the lines.
Margins
Use 1” margins all around. Note that margins may be adjusted to keep
correspondence to one page.
Address
• Start the address on line 9 (at 2.5” from the top of the page).
• Spell out the name of locators (e.g., Street, Avenue).
• Spell out the state (Georgia, not GA).
• Insert two spaces between the state and the zip code.
Page Numbers
and Headers
• Omit the page number from the first page.
• At the top of each subsequent page, place a header with the same information that
appears on the first line of the address.
Example:
Page 2 – The Honorable Johnny Isakson
Note: For instructions on creating a header, see Appendix E. For instructions on
preparing correspondence signed by the HHS Secretary, see Chapter 8.
36
Paragraphs
• Do not indent paragraphs.
• Insert a blank line between paragraphs.
Sentences
Insert one space after the period at the end of each sentence.
Note: For instructions on setting the spacing, see Appendix E.
Enclosures
If appropriate, leave one blank line after the signature block and insert the word
Enclosure or Enclosures. Be sure to mention the enclosure(s) in the body of the letter.
| The CDC Correspondence Manual
The following sample letter highlights formatting guidelines.
Consult Appendix E for tips on formatting documents using Word 2010.
Margins are 1 inch
all the way around.
The font is 12 point,
Times New Roman-
[SAMPLE LETTER]
December 5, 2011
The Honorable Marco Rubio
United States Senate
Washington, DC 20510
Keep the letter concise
and insert a blank line
between paragraphs.
Dear Senator Rubio:
Thank you so much for your inspiring remarks at the World AIDS Day event at George
Washington University last Thursday. You spoke eloquently of the importance of global health
and HIV programs both to the global economy and to the United States.
As you know, the Centers for Disease Control and Prevention (CDC) is a major implementing
agency of the President’s Emergency Plan for AIDS Relief (PEPFAR). We use the latest science
and evidence to focus our global HIV/AIDS efforts on the most effective and cost-effective
interventions. As we work to achieve an AIDS-free generation, your support is invaluable.
I would welcome the opportunity to meet with you in Washington, DC. My staff will contact
your staff to offer additional information and assistance on these critical global health issues.
Sincerely,
If the CDC and ATSDR
acronyms are not
spelled out in the letter,
spell them out in the
signature block.
Thomas R. Frieden, MD, MPH,
Director, CDC, and
Administrator, Agency for Toxic
Substances and Disease Registry
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Parts and Features of a Letter
A letter usually contains the following parts:
1.Heading (letterhead and date)
2.Opening (address and salutation)
3.Body (main text)
4.Closing (complimentary closing, signature
block, and title)
5.References (enclosures, copy notations)
1. HEADING.
The heading contains the letterhead and
the date.
Letterhead
• Use CDC letterhead for the first page
of the letter.
• Use plain bond paper for additional
pages.
Date
• The date goes on the right side, slightly
under Atlanta, Georgia 30333.
2. OPENING.
The opening contains the correspondent’s
address and salutation. Start typing on line
9 (2.5” from the top of the page) of the first
page.
Correspondent’s Address
• Include degree(s) after the name, if
appropriate.
• Spell out all locator words (e.g., Road,
Suite, Georgia). However, note that PO
Box is not written out.
• Abbreviate titles (e.g., Mr., Ms.), degrees
(e.g., MD, MPH), and directions (e.g.,
NW, SE).
• Insert two spaces between the state and
the zip code.
Salutation
• Use Dear followed by the appropriate
salutation and a colon.
Examples: Dear Dr. McGraw:
Dear Mr. Marsh:
The following example details some formatting guidelines for addresses.
No periods with abbreviations
Robert Thomas, MD, MPH
Deputy Director
Center for Global Change
1235 Parker Lane, NW, Suite 200
Long Island, New York 11122
Spell out location words
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Insert two spaces before Zip code
The following tables present the correct way to address correspondents in the opening section of the letter.
LOCAL AND STATE GOVERNMENT OFFICIALS
PERSON
ADDRESS
SALUTATION
State Governor
The Honorable (full name)
Governor of (State)
(City, State, Zip)
Dear Governor (surname):
State Senator
The Honorable (full name)
(State) Senate
(City, State, Zip)
Dear Senator (surname):
State Representative
The Honorable (full name)
(State) House of Representatives
(City, State, Zip)
Dear Representative (surname):
Mayor
The Honorable (full name)
Mayor of (City)
(City, State, Zip)
Dear Mayor (surname):
FEDERAL GOVERNMENT OFFICIALS
PERSON
ADDRESS
SALUTATION
Cabinet Member
The Honorable (full name)
Secretary of (Department)
(address)
Dear Secretary (surname):
Senator
(In Washington, DC)
The Honorable (full name)
United States Senate
Washington, DC 20510
Dear Senator (surname):
Senator
(Local District/Office)
The Honorable (full name)
United States Senator
(address)
Dear Senator (surname):
Senator-elect
The Honorable (full name)
United States Senator- elect
(address, if given) or
Care of the United States Senate
Washington, DC 20510
Dear Senator-elect (surname):
Representative
(In Washington, DC)
The Honorable (full name)
US House of Representatives
Washington, DC 20515
Dear Representative
(surname):
Representative
(Local District/Office)
The Honorable (full name)
Member, US House of Representatives
(address)
Dear Representative
(surname):
Representative-elect
The Honorable (full name)
Representative-elect
(office address) or
US House of Representatives
Washington, DC 20515
Dear Representative-elect
(surname):
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UNIVERSITY DEGREE HOLDERS
PERSON
ADDRESS
SALUTATION
Physician
(full name), MD
(address)
Dear Dr. (surname):
PhD Holder
(full name), PhD
(address)
Dear Dr. (surname):
Professor
Professor (full name)
Department of (name)
(name of institution)
(address)
Dear Professor (surname):
4. CLOSING.
THESE REFERENCE MANUALS SHOW
MORE SALUTATIONS:
• Gregg Manual, 9th Edition (pages 544–50)
• United States Government Printing Office
Style Manual 2008, at www.gpoaccess.gov/
stylemanual/browse.html
This section contains the complimentary
closing, signature, name, and job title of the
writer. All text starts 3 inches (or 6 tabs) from
the left margin.
Complimentary Closing
• Use Sincerely followed by a comma.
Signature
3. BODY.
The body contains the main idea or ideas you
want your letter to convey. It typically has
an opening paragraph, the main point(s) of
the letter, and a closing paragraph. Highly
technical or detailed information should be
provided in an enclosure to keep the letter
clear and concise.
Main Text
• Double space the lines in drafts.
• Single space the lines in final versions.
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• Leave three blank lines for the signature
of the CDC Director.
• Leave four blank lines for the signature
of the HHS Secretary.
Writer’s Name and Degree(s)
• Insert the writer’s name and degree(s), if
appropriate.
Writer’s Job Title
• Insert the writer’s job title right under
the name (Note: do not insert the words
HHS after the job title).
When to Use Copy Notation
THE SIGNATURE BLOCK FOR THE
CURRENT CDC DIRECTOR IS
AS FOLLOWS:
Thomas R. Frieden, MD, MPH
Director, Centers for Disease Control
and Prevention, and
Administrator, Agency for Toxic
Substances and Disease Registry
If you send a copy of the final letter to people
outside of CDC, use copy notation (cc:). This
notation will indicate to the correspondent
that these individuals will also receive a copy.
!
KEEP A COPY OF THE LETTER
FOR YOUR REFERENCE.
5. REFERENCES.
The references contain enclosures, copy
notations, and blind copy notations
(if appropriate).
Enclosure(s)
• If other documents are enclosed with
the letter, type the word Enclosure or
Enclosures.
• Be sure to mention the enclosure(s) in the
body of the letter.
ENCLOSURE OR ATTACHMENT?
• Insert the word Enclosure at the
bottom of a letter.
• Insert the word Attachment at the
bottom of a memo.
Copy Notation (cc:) and Blind Copy Notation (bcc:)
These indicate who will get a copy of the letter.
General Rule for Indicating Blind Copy Notation
Drafts sent to the Division of Executive
Secretariat should have a “bcc:” listing all those
inside the agency who will receive a copy of
the letter. This internal copy notation also
includes other information such as file name
and name of preparer (see samples on the next
page). Omit this internal information from the
final version.
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Following are two samples of internal copy notations.
SAMPLE 1: GENERAL CORRESPONDENCE
bcc:
OD [the Office of the Director always gets a copy]
CDC/W [for congressional correspondence, the Washington Office gets a copy]
FMO [FMO gets a copy]
NCEH [CIO preparing the response]
CDC ID: 12345; Doc. Name: pickaname.doc [tracking number provided by the Division of the Executive
Secretariat, document name provided by the CIO]
Prepared by: LBell, ATSDR, (770) 488-4321 [first initial and last name of preparer, CIO, contact number]
Spelling verifier used by: BMarsh 11/27/11 [first initial and last name of person who spell-checked the
letter, date prepared]
SAMPLE 2: C
ORRESPONDENCE FROM THE OFFICE OF THE SECRETARY (OS),
EXECUTIVE SECRETARIAT (ES), HHS
bcc:
OD
OS/ES
NCHHSTP
OS No. 123456789
CDC ID: 12345; Doc. Name: pickaname.doc
Prepared by: SHaab, NCHHSTP, (404) 639-1234
Spelling verifier used by: LRyan 11/27/11
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SECTION III:
WRITING MEMOS AND
OTHER CORRESPONDENCE
Section III presents writing and formatting
guidelines for memos and other types of
correspondence sent within CDC or going to HHS.
This section will help you with guidelines for
submitting the following types of correspondence:
-- Memos sent within CDC
-- Correspondence sent to HHS
-- E-mail
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CHAPTER 7: MEMOS SENT WITHIN CDC
I
n addition to the writing guidelines
discussed earlier in this manual, which
also apply to memos, consider these
tips for writing effective memos.
Tips for Writing Memos
Sent Within CDC
• Address only one topic per memo. If you
need to convey information about more
than one topic, write a different memo for
each one.
• Be short but specific in the Subject line
(e.g., instead of writing Restructuring,
write CDC/ATSDR Senior Management
Team Restructuring).
• Be clear and concise but provide
background information in the
introductory paragraph, unless the
recipients already know the topic of the
memo.
• Use the word Attachment, not the word
Enclosure, when attaching additional
material to a memo.
Note: Because they disseminate news
to keep employees informed about
CDC events or policies, certain types of
e-mails—such as OD, CDC, or OHS
announcements—also function as memos
and should follow the same guidelines. For
more on e-mail, see Chapter 9.
The great artist
is the simplifier.
- Henri Amiel
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Formatting Memos Sent Within CDC
The following table details the formatting conventions for memos sent within CDC.
TOPIC
FORMAT
Font
Use Times New Roman, point size 12. If size 12 does not fit, adjust
margins or use size 11.5.
Justification (Text Alignment)
• Align text left.
• Do not justify (make straight) the right margin.
Letterhead
Print on CDC letterhead (first page only).
Line Spacing
• Draft: double space the lines.
• Final: single space the lines.
Margins
Margins should be 1-inch all around.
• Omit the page number from the first page.
• Place the page number and the name of the person to whom the
memo is going in a header at the top of subsequent pages.
Page Numbers and Headers
Example:
Page 2 – The Director
Note: For information on how to create a header, see Appendix E.
Paragraphs
Sentences
Attachments
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• Do not indent paragraphs.
• Insert a blank line between paragraphs.
Insert one space after the period at the end of each sentence.
Note: For instructions on setting the spacing, see Appendix E.
If appropriate, leave one blank line after the signature block and insert
the word Attachment or Attachments. List the attachment(s) on the
next line.
Following is a sample memo sent within CDC.
TO:
Director, Centers for Disease Control and Prevention
FROM:
Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
DATE:
July 21, 2011
SUBJECT:Invitation for Assistant Secretary for Health Howard Koh to Speak During the
Opening Plenary Session at the 2011 National HIV Prevention Conference, August
14, 2011, in Atlanta, Georgia.
Issue
The Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention would like to invite Assistant Secretary Koh to provide a
welcome address at the 2011 National HIV Prevention Conference on August 14, 2011, from 4:15
p.m. – 4:25 p.m.
Recommendation
We request that you sign the attached decision memo and letter inviting the Assistant Secretary to
speak at the 2011 National HIV Prevention Conference.
BACKGROUND
CDC, in cooperation with other federal agencies and numerous private-sector organizations, is
co-sponsoring the 2011 National HIV Prevention Conference, August 14-17, 2011, at the Hyatt
Regency Atlanta and Marriott Marquis hotels in Atlanta, Georgia. Approximately 3,000 public
health professionals, clinicians, community organization representatives, and advocates involved in
HIV prevention have been invited to this conference. These groups, convened by CDC, represent
public and private organizations whose interaction, cooperation, and coordination are crucial to
successful efforts to prevent HIV and AIDS in the United States.
We would like to invite the Assistant Secretary to provide ten minutes of remarks during the
opening ceremony of the 2011 National HIV Prevention Conference. We believe that the Assistant
Secretary’s participation will demonstrate HHS’ support of efforts to end the HIV/AIDS epidemic
in the United States. In the year since the publication of the National HIV/AIDS Strategy, HHS has
shown substantial leadership in its implementation and coordination across departments. Despite
challenging economic times, the HHS fiscal year 2011 investments in HIV prevention, treatment,
care, and research remain robust, further demonstrating HHS’ commitment to making real gains in
the fight against HIV at home and abroad. This conference would provide an opportunity for the
Assistant Secretary to speak directly to our key constituents about his vision for our national HIV
response and HHS’ continued commitment to the fight against this disease.
Kevin Fenton, MD, PhD, FFPH
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Attachments:
Tab A – Draft Agenda
Tab B – Letter of Invitation
Tab C – Decision Memo to Assistant Secretary Koh
Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments:
_________________________
Thomas R. Frieden, MD, MPH
Director
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CHAPTER 8: CORRESPONDENCE SENT TO HHS
F
rom time to time you may have to
send specific memos to HHS, such
as decision (simple or complex),
briefing, or information memos.
Writing Memos Sent to HHS
Following are guidelines for developing
these memos. You can find sample
memos in Appendix F.
SIMPLE DECISION MEMOS
Simple decision memos address a single,
straightforward issue and should not exceed two
pages. These memos can be used to seek approval
to release a report or issue a non-controversial
regulation, to invite a speaker to a conference,
or other basic action. They can also be used
to request approval to issue a lengthy report,
plan, or other document. If doing so, include
an abbreviated summary and two copies of the
report. Submit lengthy background material,
when necessary, as tabbed attachments.
The Issue section should contain a concise
statement (preferably one sentence or a short
paragraph) describing the issue or request. If the
memo is an invitation, include the invitation in
this section, along with details (e.g., dates, times).
The Secretarial Action section should state the
action recommended by CDC, as well as the date
the action is requested by.
The Background section should contain pertinent
information regarding the origin, background,
and implications of the issue or problem. It
should also contain a brief statement explaining
why the Action Requested By date should be met.
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Below is an example of a simple decision memo. All other memos follow the same basic
guidelines. You can find more samples in Appendix F.
TO:
The Secretary
Through: DS ____
COS ____
ES ____
FROM:
Director, Centers for Disease Control and Prevention
Commissioner, Food and Drug Administration
Director, National Institutes of Health
DATE: October 17, 2011
SUBJECT: Presidential Proclamation Recognizing November 14–20, 2011, as Get Smart About
Antibiotics Week
Issue
The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, and the
National Institutes of Health request submission to the White House of a presidential proclamation
recognizing November 14–20, 2011, as Get Smart About Antibiotics Week.
Secretarial Action
We ask that you sign the attached memorandum and forward the presidential proclamation to the
White House for approval.
BACKGROUND
Thousands of Americans will become ill with respiratory infections throughout the year and may
unnecessarily use antibiotics. At this time of year, when many Americans are thinking about cold
and flu season, it is particularly important to call attention to the appropriate use of antibiotics.
The number of bacteria resistant to antibiotics has increased in the last decade and many bacterial
infections are becoming resistant to the most commonly prescribed antibiotic treatments. Misuse of
antibiotics jeopardizes the usefulness of essential drugs. Decreasing inappropriate antibiotic use is
an important strategy in the fight to control antibiotic resistance.
Proclaiming the week of November14–20, 2011, as Get Smart About Antibiotics Week will raise
the profile of the important public health issue of antibiotic resistance—one of the world’s most
pressing public health problems—and improve antibiotic use behavior.
Thomas R. Frieden, MD, MPH Margaret A. Hamburg, MD
Francis S. Collins, MD, PhD
Attachments:
Tab A – Transmittal Memorandum to the White House
Tab B – Presidential Proclamation: Get Smart About Antibiotics Week
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Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments:
_________________________
Kathleen Sebelius
Secretary
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COMPLEX DECISION MEMOS
Complex decision memos present an issue that
is not straightforward and for which a variety of
alternatives or options need to be presented. You
should clearly present the issue(s) and relevant
background information, with pros and cons for
each option presented in bulleted form.
Present options in a neutral fashion so as not to
favor any one side.
The Issue section should contain a concise
statement (preferably one sentence or a short
paragraph) describing the issue(s) or request(s).
The Secretarial Action section provides a
recommendation regarding the suggested
course of action, as well as the date the action is
requested by.
The Background section should contain pertinent
information regarding the origin, background,
and implications of the issue(s) or request(s). It
should also contain a brief statement explaining
why the Action Requested By date should be met.
Each option should be listed clearly and
concisely in its own numbered Recommendation
section (i.e., Recommendation 1, Recommendation
2). Each option should be followed by a
discussion that includes information about who
would benefit if the option were chosen; who
would be adversely affected; how those affected
are anticipated to react; and how much the
option will cost in terms of dollars, staff, and
administrative responsibilities. The pros and
cons of each option should follow, in bulleted
form.
Following each Recommendation section, a
Decision section should provide approval/
disapproval lines for the addressee’s use.
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Following are items to include when drafting
complex decision memos:
• A clear and concise explanation of the issue
requiring a decision (preferably a short
paragraph about the issue/request).
• A framework for the decision to be made
in the form of chronological background
information. Do not overwhelm the
presentation with details.
• A minimum of two options.
• Anticipated reactions from external groups
(e.g., Congress, industry, states) in the
Recommendation section.
• A minimum of two pros and two cons for
each option. Present them in a balanced
fashion.
• Costs of options, if available/applicable.
• Date/time frame in which a decision is
required only if a true time constraint exists
(explain in the Background section).
BRIEFING MEMOS
Use briefing memos to brief HHS officials on
a public health issue or to provide information
for an upcoming event (e.g., meeting, speech,
hearing). These memos should contain clear and
concise information to familiarize HHS officials
with the purpose of the briefing.
The Background section should contain
information about the issue at hand. When
appropriate, include questions that may be
raised in the Issues of Concern section. The
Discussion section should summarize HHS’
current or previous responses to each of the
issues addressed in the Background section.
When appropriate, provide talking points.
Formatting Memos Sent to HHS
The following table details the formatting conventions for memos sent to HHS.
TOPIC
FORMAT
Font
Use Times New Roman, point size 12. If size 12 does not fit, adjust margins
or use size 11.5.
Justification
(Text Alignment)
• Align text left.
• Do not justify (make straight) the right margin.
Letterhead
Print on CDC letterhead (first page only).
Line Spacing
• Draft: double space the lines.
• Final: single space the lines.
Margins
Use 1” margins all around, with the first line of text starting on line 9 (at 2.5”
from the top of the page).
• Omit the page number from the first page.
• Center the page number at the bottom of subsequent pages.
Page Numbers
and Headers
Example:
-2Note: For information on how to create a header, see Appendix E.
Paragraphs
Sentences
Attachments
• Do not indent paragraphs.
• Insert a blank line between paragraphs.
Insert one space after the period at the end of each sentence.
Note: For instructions on setting the spacing, see Appendix E.
If appropriate, leave one blank line after the signature block and insert the
word Attachment or Attachments. List the attachment(s) on the next line.
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Writing Other Correspondence
Sent to HHS
Following are guidelines for summary
statements (in-house and secretarial
correspondence).
RESPONSIVE SUMMARY STATEMENTS—
SECRETARIAL CORRESPONDENCE
When HHS assigns a CIO a letter that requires
the Secretary’s signature, a responsive summary
statement written by the CIO must accompany
the draft response submitted to the Division of
Executive Secretariat. The responsive summary
statement serves as a cover page summarizing
the response, and should serve as a stand-alone
document that does not exceed one page.
Responsive summary statements should include
the following information:
• Name(s) of correspondent.
• Subject/issues raised by the correspondent.
• Major points in the response.
• Other pertinent information.
• Contact person(s).
TRANSMITTAL SUMMARY STATEMENTS—
SECRETARIAL CORRESPONDENCE
When the CIO initiates communication
with the Secretary, a transmittal summary
statement written by the CIO accompanies the
correspondence. Like a responsive summary
statement, the transmittal summary statement
serves as a cover page summarizing the draft
memo the CIO submits to the Division of
Executive Secretariat. It serves as a stand-alone
document and does not exceed one page.
Transmittal summary statements include the
following information:
• Subject/issues/OPDIV
• Summary
• Recommendation
• Contact person(s)
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IN-HOUSE SUMMARY STATEMENTS—
CIO-ORIGINATED CORRESPONDENCE
An In-House Summary Statement is included
with CIO-originated correspondence going
to CDC’s Division of Executive Secretariat
for the signature of the CDC Director or the
CDC executive leadership team. The in-house
summary statement must include a oneparagraph justification explaining why the CIO
is requesting the specific action or signature of
the above-mentioned persons. The paragraph
should include the following information:
• Subject
• Purpose
• Summary and concerns (if any)
• Recommended action(s)
• Contact person(s)
• Telephone number
HHS/IOS/ES TRANSMITTAL MEMOS
HHS/IOS/ES Transmittal Memos accompany
all proposed regulations sent to HHS for review/
clear. The transmittal memo, signed by the
CDC Director, provides the issue, background
or discussion, and a recommendation that
the Secretary approve the Federal Register
notice announcing the rule. In addition to
the information typically included in a simple
decision memo, an HHS/IOS/ES transmittal
memo outlines the audience, purpose,
distribution, and release date of the proposed
rule. A summary statement accompanies the
transmittal memo.
For more information about the Executive
Secretariat clearance process, see Appendix G.
APPENDIX F has examples of each type of
correspondence discussed in this chapter.
CHAPTER 9: GUIDELINES FOR E-MAIL
E
-mail is one of the most widely
used means of communication
at CDC. You should use the
same care and caution drafting
e-mails as you would writing letters or
memos. Following are a few rules of
“netiquette” to ensure that your e-mail
is effective and professional.
ACTIVATING THE SPELL CHECKER
IN OUTLOOK
1. On your Outlook toolbar, select Tools,
Options.
2. Select the Spelling tab.
3. Check the first two options.
4. Click OK.
Formatting E-mails
Writing E-mails
Grammar. Use correct grammar,
punctuation, and spelling. Be sure the
Always check spelling option is checked and
activated (see box for instructions).
Style. Compose brief single-topic messages.
Tone. Be courteous and respectful. Because
e-mails cannot convey tone very well, it is
easy to unintentionally offend your reader.
Never be rude, sarcastic, or caustic.
Content. An e-mail is a public document.
Only write messages that you would not be
embarrassed to see disseminated in public.
Even though you may think your message is
private, it is not.
Topic. Do not send chain letters,
doubtful humor, or anything else that is
unprofessional.
Subject Line. Use a short, descriptive subject
line. Never leave the subject line blank; your
message may get deleted without being read.
Signature. Use a signature block. Include all
pertinent information, such as your title, the
name of your office, and your phone and fax
numbers. You may also consider including
your CIO’s web address.
All Caps and Lowercase. Do not write in all
caps or all lowercase letters. Both make your
message hard to read, and writing in all caps is
the equivalent of shouting.
Sending E-mails
Hostile Mail. Think twice before sending that
scathing message. Before venting your anger,
ask yourself:
• Would I say this to the
person face-to-face?
• Will this put the reader in
an awkward position?
• How would I feel if I received
this message?
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Forwarding. Do not forward messages
indiscriminately. When forwarding someone
else’s e-mail, ask the original writer’s permission
if the message contains personal information.
Delaying, Recalling,
or Replacing a Message
Reply to all. When replying to a message that
was sent to multiple readers, decide if you need
to reply just to the sender or to everyone on the
list.
You can compose a message that will be sent
at a later time and date of your choice.
Using cc:. Send copies (cc:) only to those who
really need a copy.
Using bcc:. This feature allows you to copy a
third party without the original correspondent
knowing about it. Use it with care: if the original
correspondent discovers you copied someone
without their knowledge, it may put you in an
unflattering light.
Attachments. Do not send attachments if the
text is sufficient. Attachments take up space and
increase downloading time.
DELAYING DELIVERY OF A MESSAGE
1.Compose your e-mail.
2.On your Outlook toolbar, click Options.
3.Under More options, select Delay
delivery.
4.Check the Do not deliver before box.
5.Select the date and time you want the
e-mail to be sent.
6.Click Close.
7.Click Send, just as you would any
other message.
RECALLING OR REPLACING A MESSAGE
You can only use these features if the recipient
is using Microsoft Outlook and has not yet read
the message. When you send a recall notice,
it will show up in the recipient’s inbox. If the
recipient does not open either the original
message or the recall notice, both messages will
disappear from the inbox within one minute of
the recall notice.
1.Open the Sent Items folder.
2.Open the message you wish to recall.
3.Select the Message tab.
4.Under Move, click Actions, Recall This
Message.
5.Select the appropriate option (you can
either delete unread copies of the message
or replace it with another message) and
click OK.
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SECTION IV:
APPENDICES AND
REFERENCES
Section IV contains a variety of useful resources that
give specific technical and clearance guidance related
to official correspondence, including:
Appendix
Appendix
Appendix
Appendix
A.
B.
C.
D.
One Word or Two? List
Jargon
Tautologies and Redundancies
Checklist for Writing and Formatting
Appendix E. Word 2010 Help
Appendix F. Sample Correspondence
Appendix G. The Executive Secretariat Clearance Process
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APPENDIX A: ONE WORD OR TWO?
after-school program
allover
anti-inflammatory
antitobacco
back-order (v)
backup (n), back up (v), back-up (adj)
bedbug
bed net (n), bed-net (adj)
birth weight*
bloodborne
breast-feed*
breakup (n), break up (v)
built-in (adj)
buy in
by-product
caregiver
case-patient
CD-ROM
checklist
checkup
chickenpox
childbearing
child care
cleanup (n)
clean-up (adj)
clear-cut
clockwise
coinfection
comorbid
counter marketing
coworker
crosscutting
cross section
cut off (v), cutoff (n, adj)
data set
database
day care (n), day-care (adj)
decision maker
decision making (v), decision-making (adj)
dropout (n), drop out (v), drop-out (adj)
e-mail
end user
everyday (adj)
fact sheet
fade-out
fast-food (adj)
fieldwork
field-worker
fingerstick
flier (person)
flyer (fact sheet)
flip chart
follow-up (n), follow up (v)
foodborne
food service
fresh water (n), freshwater (adj)
frontline (adj), front line (noun)
fund-raiser
groundwater
hand-carry
hands-on (adj)
handwashing
health care
HIV-positive
hotspot
in-depth
in-house
in-kind
inpatient
in-store
in utero
kickoff (n), kick off (v), kick-off (adj)
kindergarten
kindergartner
life cycle
lifelong
The CDC Correspondence Manual
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lifetime
Listserv
live-born
lockup
longstanding
long-term
lunchtime
man-made
mosquito-borne
multiphase
nationwide
needlestick
non-English-speaking
occasional
off-line
onetime (adj)
ongoing
online
on-site/off-site
open-source (adj)
overall
outpatient
over-the-counter
pilot test
policyholder
policy maker
postcard
postmortem
postpartum
preexisting
preschool
preteen
preteen-ager
real-time
scale-up
secondhand
school-aged
schoolchildren
schoolwork
school yard
soundproof
60
| The CDC Correspondence Manual
standby (adj)
T cell (n), T-cell (adj)
tabletop
task force
tenfold (& two through ninefold)
tickborne
time line
time frame
tool box
tool kit*
top-down
troubleshoot
under way (adv), underway (adj)
up-front (adj), up front (adv)
vectorborne
walkathon
waterborne
webmaster
website
webzine
weekday
weekend
well-being
workbook
workday
work flow
workforce
work group
workload
workout (n), work out (v)
work-up (n), work up (v)
workplace
work plan
work sheet
workshop
work site*
worldwide
*Notes
Birth weight: This is the CDC preferred
spelling, but birthweight is also acceptable.
Breast-feed: This is the CDC preferred spelling,
but breastfeed is also acceptable.
Tool kit: This is the CDC preferred spelling, but
toolkit is also acceptable.
Work site: This is the CDC preferred spelling,
but worksite is also acceptable.
Below is a list of common prefixes. Hyphenation
is not necessary, except as noted.
ante
anti
co
counter
de
extra
infra
inter
intra
macro
micro
mid
multi
non
over
post
pre
pro
pseudo
re
semi
sub
super
supra
trans
ultra
un
• Always hyphenate after the prefixes “self-” and
“cross-”. self-aware, self-sticking, cross-react
• Most common suffixes are joined without a
hyphen: -fold, -hood, -less, -like, -wide, and
-wise, unless doing so creates an unclear or
excessively long word, triples a consonant
(bell-like), follows a proper noun (Whitmanlike), or follows a number (10-fold, 2.5-fold).
• Do not hyphenate after an adverb ending in
–ly, even when used in a compound modifier
preceding the word modified.
- The rapidly rising temperature caused…
• Do not hyphenate foreign phrases that are
printed open in other circumstances (e.g., in
vitro translation, in situ protein synthesis, in
vitro–stimulated growth, in situ–synthesized
proteins).
Exceptions are
• Before a capital letter (un-American, subSaharan).
• Before an abbreviation or acronym (nonmRNA).
• Before a numeral (pre-1970).
• To avoid confusion with a similar
unhyphenated word (re-cover, re-creation).
• To avoid a confusing meaning, as in
immunologic terms such as anti-rabbit, antigoat, anti-mouse, anti-human. “Goat antirabbit IgG” means goat antiserum against
rabbit IgG, not goat IgG that is anti-rabbit.
• Even if letters are doubled, common prefixes
are usually not joined by hyphens.
- antiinflammatory
- intraabdominal
- nonnegotiable
- posttraumatic
The CDC Correspondence Manual
| 61
APPENDIX B: JARGON
AVOID
PREFER
A
62
AVOID
PREFER
at the present time
now
at the time that
when
attain
reach
augment
increase
a considerable
amount
much
a considerable
number
many
accomplish
do, achieve
B
accordingly
so
by means of
accumulate
gather
C
acquire
get
close proximity
near
activate
begin, start
commence
begin, start
adequate number of
enough
completion
end
adjacent to
next to, near
comply with
follow, obey
advantageous
useful, helpful
components
parts
afford the opportunity
allow
conceal
hide
allocate
give
concerning
about
along the lines of
like, as in
construct
build
ameliorate
improve
contrary to
against
an estimated
about
cumulative
added
as consequence of
because
currently
now
as a result of the fact
that
because
customary
usual
as long as
if, since
as regards
about
as well as
and, also
at all times
always
at an early date
soon (or say when)
at the moment
now
| The CDC Correspondence Manual
by
D
depict
show
demonstrate
show, prove
desist
stop
despite the fact that
although, though
detrimental
harmful
disconnect
cut off, unplug
AVOID
PREFER
AVOID
PREFER
disseminate
send, distribute,
spread
for the reason that
because
formulate
work out, devise
due to the fact that
because
frequently
often
duplicate
copy
functionality
function
during the course of
during
fundamental
basic
during the time that
while
during which time
while
E
G
give rise to
cause
I
effect (v)
make
effectuate
bring about, carry out
elucidate
explain
employ
use
endeavor to
try
enquire
ask
ensuing
illustrate
show
impact (v)
affect, influence
implement
carry out, do
in almost all instances
nearly always
in a number of cases
in some cases
(or say how many)
following
in a timely manner
promptly, soon
equivalent
equal
in addition to
and , also
evaluate
test
in advance
before
except when
unless
in case of
if
in conjunction with
and, with
in most cases
often, mostly
in order to
to
F
facilitate
make easier, ease,
help
facilities
building, laboratory,
office
in reference to
about
feasible
possible
in spite of the fact that
despite
feedback
comments, response
in terms of
about
finalize
complete, conclude,
finish
in the absence of
without
in the amount of
for
in the context of
in
in the course of
during, while
in the event of
if
following
after
for the duration of
during, while
for the purpose of
for
The CDC Correspondence Manual
| 63
AVOID
PREFER
AVOID
in the near future
soon
N
in the neighborhood
about, around
necessitate
require, need
in the vicinity of
near
nevertheless
but, however
is in position to
can
not in a position to
unable
it is clear that
clearly
O
it is incumbent upon
us
we must
objective
aim, goal
observe
see
in view of the fact
as, because
obtain
get
it would appear that
apparently
on a regular basis
regularly
it is probable that
probably
on behalf of
for
inception
start
first
on numerous
occasions
often
initial
input
comment
on the condition that
if
inquire
ask
on the grounds that
because
institute (v)
begin set up, start
on the occasion that
when, if
on the part of
by
operate
use
operational
working, active,
running
L
large number of
many
(or say how many)
linkage
link
listing
list
otherwise
or
location, locality
place
output
product
M
P
magnitude
size
paradigm
pattern, example
manner
way
parameter
manufacturer
make
boundary, limit,
extent
materialize
occur, happen, appear
partially
partly
methodology
methods, procedure
permit
let
mitigate
moderate, ease,
soften, relieve, reduce
pertaining to
about
place (v)
put
portion
part
moreover
64
PREFER
| The CDC Correspondence Manual
besides, also, and
AVOID
PREFER
AVOID
PREFER
predominant
main
sufficient
enough
preparatory to
before
T
presently
soon, shortly
consider
previous to
before
take into
consideration
prioritize
rank
terminate
end, finish, stop
procure
get, obtain
the majority of
most
prolonged
long
thereafter
then
provided that
if
through the use of
by, with
purchase
buy
transmit
send
transpire
happen, occur,
take place
R
about, on
regarding
U
rule
regulation
ultimate
last, final
rest
remainder
uniform
same, similar
is
represents
unoccupied
empty
ask
request (v)
until such time
until
need
require
upon
on
live, stay
reside
utilization
use
home, house
residence
utilize
use
keep
retain
V
S
viable
possible
solely
only
virtually
almost
state (v)
say
visualize
see
statutory
legal, by law
W
strategize
plan
with regards to
subsequently
later
subsequent
next
subsequent to
other
substantial
big
substantiate
prove
about
The CDC Correspondence Manual
| 65
APPENDIX C: TAUTOLOGIES AND REDUNDANCIES
SUPERFLUOUS
CORRECT
A
CORRECT
controversial issue
issue
absolutely complete
complete
cooperate together
cooperate
absolutely essential
essential
costs a total of
costs
actual, past/present
experience
experience
current status
status
added bonus
bonus
advance planning
planning, notice
already exist
exist
and also
and, also
(but not both)
D
ask the question
ask
assembled together
assembled
at about
at, about
(but not both)
B
basic fundamental
basic, fundamental
(but not both)
C
66
SUPERFLUOUS
cancel out
cancel
cd-rom disk
cd-rom
center around
center
clearly evident
evident
blue/red/yellow in
color
blue/red/yellow
completely destroyed
destroyed
complete monopoly
monopoly
consensus of opinion
consensus
contributing factor
factor
| The CDC Correspondence Manual
doctorate degree
doctorate
E
each and every
each, every
(but not both)
exactly identical
identical
extremely minimal
minimal
F
few in number
few
filled to capacity
filled
final outcome
outcome
first and foremost
first
foreign imports
imports
future plans
plans
G–H
general public
public
hiv virus
hiv
I
if and when
if, when (but not both)
it is clear
(omit)
it is obvious
(omit)
SUPERFLUOUS
CORRECT
SUPERFLUOUS
CORRECT
T
J–L
join together
join
temporary loan
loan
large in size
together
time period
time, period,
(but not both)
total number
total
true fact
fact
12 noon/ 12 midnight
noon, midnight
M
mixed together
mixed
month of January
January
more and more often
often
U
N
new breakthrough
breakthrough
none at all
none
unite together
unite
usual habit
habit
V
O
over and over again
repeatedly
overexaggerate
exaggerate
visible to the eye
visible
P
past history/
experience
history, experience
period of time
period, time
(but not both)
point in time
now, today
postpone until later
postpone
R
repeat again
repeat
S
small in size
small
square in shape
square
still remains
remains
sum total
total
The CDC Correspondence Manual
| 67
APPENDIX D: CHECKLIST
Use this checklist to ensure that your letter is written and formatted correctly.
FORMATTING
99
99
99
99
99
99
99
99
Are the margins correct (1” for letters)?
Is the line spacing correct (single-spaced finals, double-spaced drafts)?
Is there only one space after each sentence?
Is the text justified on the left side only?
Is there a blank line between paragraphs?
Are the paragraphs flush left (not indented)?
Are the pages numbered (no number for page 1, header for other pages)?
Does the header have the correct information?
ADDRESS AND SALUTATION
99
99
99
99
Does the address start on line 9 (at 2.5” from the top of the page)?
Is the salutation correct?
Are the necessary words spelled out (Street, not St.; Georgia, not GA)?
Are there two spaces between the state and the Zip code?
SPELLING
99 Did you use the spell checker (F7 key)?
99 Did you avoid symbols (percent, not %)?
MECHANICS (CAPITALIZATION, ABBREVIATIONS, ACRONYMS)
99 Did you avoid unnecessary capitalization of words?
99 Are acronyms spelled out the first time they appear in the text, followed by
the acronym in parentheses?
68
| The CDC Correspondence Manual
APPENDIX E: WORD 2010 HELP
F
ollowing are instructions and tips
to help you use Word 2010 more
efficiently. You must be in Word
2010 to perform the instructions below.
Setting Margins
The standard margin size for CDC
correspondence is 1” on all sides. However, the
default margin settings in Word 2010 are as
follows: 1” margins at the top and bottom of the
page, and 1.25” margins at the left and right of
the page. To change the default settings to 1”
margins all around, follow the directions below.
1.On your toolbar, click Page Layout, Page
Setup.
2.Select the Margins tab.
3.In the Margins section, select 1” in the
Top, Bottom, Left, and Right boxes.
4.Click Set as Default (bottom left of the
window) and Yes.
Every document you open will now have 1”
margins all around.
Inserting a Header
into a Document
Letters that have two or more pages need to
have a header at the top of every page, except
the first page, which should be CDC letterhead.
The header contains information such as page
number and title of document.
INSERTING THE HEADER
1.Place your cursor on the second page of
your document.
2.On your toolbar, select the Insert tab.
3.Select Header and click Edit header.
4.A Design tab will appear.
5.Check the Different first page box.
6.Type the word Page in the Header box
and insert a space.
7.Go to the Header and Footer tab and
click the Page Number button.
8.Select Current position to automatically
insert the page number in the header.
9.Insert another space, an en dash,
another space, and then the title of your
document.
(Note: For more on inserting en dashes,
see inset box and the section below.)
10. Click Close Header and Footer to go
back to your document.
ELIMINATING THE HEADER
1.Double-click the header.
2.Highlight the text in the header and
delete it.
3.Click Close.
Inserting the en or em Dash
1.Place the cursor where you want to insert
the en or em dash in the text.
2.On the toolbar, click Insert.
3.Click Symbol, More Symbols.
4.Under Font, select (normal text).
5.Under Subset, select General
Punctuation.
6.Double-click the – or — symbol.
7.Click Close.
The CDC Correspondence Manual
| 69
THE DIFFERENCE BETWEEN HYPHENS
AND DASHES
Hyphens and dashes are not
interchangeable.
• A hyphen (-) separates compound words
(e.g., double-click).
• An en dash (–) indicates ranges
(e.g., 1990–1995).
• An em dash (—) indicates a break in
thought or sentence structure (e.g., He
came to the meeting—for the first time
ever—and spoke up).
Spacing between Sentences
The standard used for most documents (e.g.,
books, reports, newspapers) requires only one
space between sentences. This creates a tighter
text effect and makes words easier to read. You
can set the spell checker to check that you have
the desired spacing between sentences in your
document.
SETTING THE SPELL CHECKER TO CHECK
CORRECT SENTENCE SPACING
1.On your toolbar, click Review, Spelling &
Grammar.
2.Click Options.
3.Select the Proofing tab.
4.Under the When correcting spelling and
grammar in Word heading, click Settings.
5.Under Require, find the Spaces required
between sentences line (third line) and
select the number of spaces you want from
the drop-down list.
6.Click OK and click OK.
Drafts and Watermarks
A draft is a work in progress that only reviewers
should see at this stage. You can identify the
document as a draft by inserting a watermark
on each page. A watermark can be a graphic or a
word that appears in grey behind the text.
INSERTING THE DRAFT WATERMARK
1.On your toolbar, go to Page Layout and
click the Watermark drop-down tab.
2.Select DRAFT (or another text).
Note: To eliminate the watermark, repeat
Step 1, then click Remove watermark.
Converting a Word 2010
File into a PDF File
The Adobe Portable Document Format (PDF)
converts documents into a reliable format that
can be viewed and printed on various platforms
while preserving the look of the original
document. For example, if you want to share a
document that was created in Word 2010 with
someone who does not have Word 2010, you can
convert the document into a PDF file, which
your correspondent will be able to read and
print (but not alter electronically).
1.Open the Word 2010 document you want
to convert.
2.From the File tab, select Print.
3.In the Printer drop-down box, select CDC
PDFWriter.
4.Click Print to open the Save PDF File As
window.
5.Choose a file name and location and click
Save.
6.Exit Word 2010 and open the PDF file
from its current location.
Note: Do not try to open the PDF file in
Word 2010; you will be unable to view it.
70
| The CDC Correspondence Manual
Shortcut Keys
Using the keyboard shortcut keys instead of the mouse to execute commands will save you time, once
you memorize the commands.
GENERAL
FORMATTING
KEY
RESULT
KEY
RESULT
F1
Open Microsoft Help
CTRL + B
Boldface the selected text
F4
Repeat the last action performed
CTRL + I
Italicize the selected text
F5
Open the Find, Replace, and Go
To tabs
CTRL + U
Underline the selected text
F7
Open the Spelling and Grammar
window
F12
Open the Save As window
EDITING
OTHER
KEY
RESULT
CTRL + F
Open the Find and Replace
window
CTRL + N
Open a new document
KEY
RESULT
CTRL + O
Open an existing document
CTRL + A
Select (highlight) the entire
document
CTRL + S
Save
CTRL + X
Cut the selected text
CTRL + P
Print
CTRL + C
Copy the selected text
CTRL + V
Paste the selected text
CTRL + Z
Undo the last action
CTRL + Y
Redo the last action
In addition to the list provided, you may visit www.
keyxl.com/aaa2cd7/445/Microsoft-Word-2010keyboard-shortcuts.htm for a comprehensive list of
shortcut keys available in Word 2010.
The CDC Correspondence Manual
| 71
APPENDIX F: SAMPLE CORRESPONDENCE
•
•
•
•
•
•
•
72
Basic Letter
Responsive Summary Statement
Transmittal Summary Statement
In-house Summary Statement
Simple Decision Memo
Complex Decision Memo
HHS/IOS/ES Transmittal Memo
| The CDC Correspondence Manual
Sample Letter
March 21, 2011
Ms. Dorothy Gale
1193 Yellow Brick Road
Middleof, Kansas 67123
Dear Ms. Gale:
Thank you for your letter regarding traffic emissions-related deaths in Farm County, Georgia.
Although there are academic studies available describing our understanding of the health
effects of traffic emissions, CDC does not collect the information you have requested.
In any urban area, the air we breathe is made up of a complex mix of pollutants—both natural
and man-made. Traffic emissions; industrial emissions; cigarette smoke; and natural sources
including pollen, dust, and emissions from wildfires or volcanoes are only part of what mixes
into our air, affecting our air quality. Traffic emissions represent a mixture of pollutants
including carbon dioxide, carbon monoxide, benzene, and many others. The pollutants from
vehicle emissions can also differ depending on the type of vehicle. These complex mixtures
make it very difficult to accurately measure a person’s exposure to one specific source such as
traffic emissions. As a result, estimating adverse health effects or potential deaths from specific
air pollution sources can be very challenging.
Many studies have shown links between specific air pollutants—such as ozone—and various
health effects, but the direct links between traffic pollution and health are still unclear. The
level of risk can depend on factors including the amount of pollution in the air, the amount of
air that we breathe at a given time, and our overall health status. One helpful resource is the
Executive Summary from the recent state-of-the-science report by the Health Effects Institute,
Traffic-related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and
Health Effects, which provides a current review of what is known about traffic emissions and
health. You can find this document at: http://pubs.healtheffects.org/getfile.php?u=552.
Thank you for your interest in this important public health issue. We hope this information will
be helpful to you.
Sincerely,
Thomas R. Frieden, MD, MPH
Director, CDC, and
Administrator, Agency for Toxic
Substances and Disease Registry
The CDC Correspondence Manual
| 73
Sample Transmittal Summary Statement
TRANSMITTAL SUMMARY STATEMENT
SECRETARIAL CORRESPONDENCE
SUBJECT/ISSUE/OPDIV:
The Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention would like to invite White House Advisor Jeffrey
Crowley to provide a 15–20 minute inspirational address and remarks at the 2011 National HIV
Prevention Conference on August 14, 2011, from 5:00 p.m. to 5:15 p.m.
SUMMARY:
CDC is co-sponsoring the 2011 National HIV Prevention Conference. Approximately 3,000
public health professionals, clinicians, community organization representatives, and advocates
involved in HIV prevention have been invited to this conference. These groups represent
public and private organizations whose interaction, cooperation, and coordination are crucial to
successful efforts to prevent HIV and AIDS in the United States.
As the President’s lead advisor on HIV/AIDS policy, Mr. Crowley’s participation will provide
valuable insight into the White House perspective on the HIV National Strategy Plan.
RECOMMENDATION:
We ask that the Secretary agree to invite Mr. Crowley to speak at the 2011 National HIV
Conference.
CONTACT PERSON: J. Ronald Campbell, CDC/OD/DES, (404) 639-7120
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| The CDC Correspondence Manual
Sample Responsive Summary Statement
RESPONSIVE SUMMARY STATEMENT
SECRETARIAL CORRESPONDENCE
NAMES OF CORRESPONDENTS:
Raymond Gist, DDS, President, American Dental Association, and Kathleen T. O’Loughlin,
DMD, MPH, Executive Director, American Dental Association
SUBJECT/ISSUES RAISED BY CORRESPONDENTS:
Drs. Gist and O’Loughlin write to Secretary Sebelius expressing their concerns about the oral
health organizational structure at the Department of Health and Human Services’ (HHS) Centers
for Disease Control and Prevention (CDC).
MAJOR POINTS IN THE RESPONSE:
- CDC’s National Center for Chronic Disease Prevention and Health Promotion’s (NCCDPHP) is
fully committed to its Division of Oral Health’s mission to prevent and control oral diseases and
conditions and reduce disparities.
- CDC serves as the lead agency for the Healthy People 2020 objective for oral health, is a full
and active participant in HHS’ 2010 Oral Health Initiative, and has publicly committed to
developing a National Surveillance Plan in collaboration with the National Institute of Dental
and Craniofacial Research.
- HHS is committed to ensuring that oral health activities provide the maximum possible public
health impact.
- NCCDPHP has successfully nurtured programs of similar size within a larger division for many
years.
- CDC believes that the ability to focus limited staff and resources on programmatic efforts, rather
than division infrastructure, enhances their public health impact.
OTHER PERTINENT INFORMATION: None.
CONTACT PERSON: J. Ronald Campbell, CDC/ES, (404) 639-7120
The CDC Correspondence Manual
| 75
Sample In-House Summary Statement
In-House Summary Statement
Invitation from Dr. Frieden to Ms. Danielle Gilbert, Office of Representative Debbie Wasserman
Schultz (FL), to attend the upcoming meeting of the Advisory Committee on Breast Cancer
in Young Women from September 21–23, 2011 at CDC headquarters in Atlanta, Georgia. We
recommend that Dr. Frieden sign the memo. Contact J. Ronald Campbell, (404) 639-7120.
76
| The CDC Correspondence Manual
Sample Decision Memo to the Secretary, HHS
TO:
The Secretary for Health and Human Services
Through: DS ____
COS ____
ES ____
FROM:Director, Centers for Disease Control and Prevention
Administrator, Agency for Toxic Substances and Disease Registry
DATE:
February 22, 2011
SUBJECT: Invitation to Speak at the 45th National Immunization Conference on Monday,
March 28, 2011, in Washington, D.C.
Action Requested By: March 4, 2011
Issue
The Centers for Disease Control and Prevention (CDC) would like to invite you to introduce
the Surgeon General, Dr. Regina M. Benjamin, who is being invited to be the keynote speaker
during the opening plenary session of the conference that will be held from 9:00 a.m. until 10:30
a.m., Monday, March 28, 2011. Your participation in the opening ceremony will demonstrate
your support of the important role that CDC’s National Center for Immunization and Respiratory
Diseases (NCIRD) and its immunization partners play in providing comprehensive immunization
coverage for all groups. This forum will provide an opportunity for you to personally address a
group of health care workers and professionals who are on the front lines in this battle.
Secretarial Action
I recommend you join CDC and our global immunization partners on March 28, 2011, to celebrate
our public health successes and re-invigorate our immunization efforts for the future.
BACKGROUND
Each year, local, state, federal, and private-sector immunization partners gather to share the
latest scientific and programmatic information, with the ultimate goal of working collaboratively
to achieve and maintain high immunization coverage levels among our nation’s citizens.
Approximately 1,600 participants—physicians, nurses, scientists, program managers, and other
public health professionals representing all 50 states and territories—are expected to attend the
conference.
In addition, we are issuing an invitation to the Surgeon General Regina M. Benjamin to give the
keynote address during the opening plenary.
The CDC Correspondence Manual
| 77
This year’s 45th National Immunization Conference will be convened March 28–31, 2011, at the
Washington Hilton, 1919 Connecticut Avenue, NW, Washington, DC 20009. This conference is
one of the largest public health events sponsored by CDC. The theme for this year’s conference is
“Immunization: Achieving Monumental Vaccine Coverage.” Draft agendas are attached for your
information (Tabs A and B).
CDC staff will be pleased to assist in the preparation of your remarks. Ms. Suzanne JohnsonDeLeon, Conference Manager, NCIRD, CDC, will be happy to answer any questions and provide
additional information regarding the conference; your staff may contact her directly at (404) 6398817 or (404) 639-8225.
Thomas R. Frieden, MD, MPH
Attachments:
Tab A - Summarized Draft Agenda
Tab B - Full Draft Agenda of All Conference Events
Tab C - Formal Invitation Letter
Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments:
_________________________
Kathleen Sebelius
Secretary
78
| The CDC Correspondence Manual
Sample Complex Decision Memo to the Secretary, HHS
TO:
The Secretary for Health and Human Services
Through: DS ____
COS ____
ES ____
FROM:Director, Centers for Disease Control and Prevention
Administrator, Agency for Toxic Substances and Disease Registry
DATE:
March 3, 2011
SUBJECT:
Smokeless Tobacco Nicotine Report
Issue
The Centers for Disease Control and Prevention (CDC) is pleased to present the Smokeless
Tobacco Nicotine Report. This report provides an analysis of the quantity of nicotine in smokeless
tobacco products, as reported by the tobacco industry. Additional information on moisture content,
pH, and unionized nicotine (also known as “un-ionized” or “free base” nicotine) is also presented.
Secretarial Action
Please provide your approval or notification of non-approval of the Smokeless Tobacco Nicotine
Report by March 31, 2011.
BACKGROUND
The Comprehensive Smokeless Tobacco Health Education Act (CSTHEA), 15 U.S.C. §4403,
requires individuals who manufacture, package, or import smokeless tobacco products in the
United States to report to the Department of Health and Human Services (HHS) the quantity of
nicotine in each smokeless tobacco product. CDC’s Office on Smoking and Health (OSH) has
primary responsibility for the HHS tobacco and health program.
Pursuant to CSTHEA, 15 U.S.C. §4403, the information contained in the report must be treated as
trade secret or confidential information subject to 5 U.S.C. 552(b)(4). Procedures for safeguarding
the data and the report, Guidelines for Maintaining and Releasing Privileged Information
Obtained in Accordance With Sec. 4(b)(2)(A) of Public Law 99-252 (15 U.S.C. 4403), were
previously published in the February 1, 1994, Federal Register (59 FR 4714) (attached).
We hope that you find this report informative. CDC is available to meet with you to discuss
future opportunities for using the scientific data contained in the report. Considering that tobacco
regulation is a priority for HHS, this report could have important implications for other HHS
agencies. CDC is also available to discuss additional steps for sharing this information outside
of HHS, within the constraints of the legislative requirements. Additionally, CDC is interested in
discussing future reporting schedules of these data.
Thomas R. Frieden, MD, MPH
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Attachments:
Tab A – Smokeless Tobacco Nicotine Report
Tab B – 15 U.S.C. 4403
Recommendation 1:
Approval of the report will allow… [Continue your recommendation here, including positive and
negative impacts, if any.]
Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments: ______________________
Recommendation 2:
Non-approval of the report will result in… [Continue your justification here, including positive
and negative impacts, if any.]
Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments:
_________________________
Kathleen Sebelius
Secretary
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Sample HHS/IOS/ES Transmittal Memo
TO:
The Secretary
Through: DS ____
COS ____
ES ____
FROM: Director, Centers for Disease Control and Prevention
DATE:
July 25, 2011
SUBJECT:Action: Review/Clear – Approval Tests and Standards for Closed-Circuit
Escape Respirators (CCERs) (42 CFR 84); Final Rule
______________________________________________________________________________
ACTION NEEDED
Review/clear of Approval Tests and Standards for Closed-Circuit Escape Respirators (CCERs) (42
CFR 84); Final Rule
SUMMARY
Audience:
The regulated entities for this rule are respirator manufacturers (3) who make
closed circuit respirators (CCERs) used for escaping atmospheres considered to
be immediately dangerous to life and health.
Purpose:This final rule addresses problems that have been identified by NIOSH and users
regarding CCERs. The rule will result in approved CCERs that provide improved
protection over those currently approved under the existing regulatory provisions
and will facilitate the introduction of new technologies.
Distribution: After approval by OMB, this rule will be published in the Federal Register.
Release Date:This rule is listed in the Spring 2011 Unified Agenda (RIN 0920-AA10).
Anticipated publication date is December 30, 2011. This rule is not included
in the retrospective review. The rule would become effective 60 days after
publication in the Federal Register.
Background: Under 42 CFR Part 84, NIOSH conducts a testing and certification process to
certify respirators manufactured for the protection of employees potentially exposed to hazardous
atmospheres. NIOSH and the Mine Safety and Health Administration (MSHA) jointly certify
such respirators for use by U.S. coal miners, including a type of respirator known in the mining
industry as a “self-contained self-rescuer,” and more generally described by NIOSH as a CCER.
Recent incidents in U.S. coal mines, while not necessarily implicating CCERs, have led to
heightened concern about the safety of coal miners. This final rule is responsive to these concerns.
This rulemaking is not significant in terms of its potential economic impact. NIOSH has consulted
with the Small Business Administration, which has approved the economic analysis presented in
the final rule. However, the change from providing certification of the duration of breathing gas
supplied to providing certification of a volume quantity of oxygen supplied is a significant policy
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change. It will require changes in MSHA regulations governing CCER use in underground coal
mining, which currently reference durations of breathing gas supply. It will also promote a shift
in practices at coal mines, where miners and operators are accustomed to relying for emergency
planning on the 1-hour duration certification of CCERs, which is required by MSHA for mine
disaster escape use.
Public comments were generally positive about the rulemaking, but did reflect concerns about
the need for new CCER standards; the change from duration to capacity ratings; and the decision
to update CCER standards exclusively rather than all types of self-contained self-rescuers. Most
significantly in response to public comments, NIOSH removed a provision that would have
required all CCER purchasers to discontinue use of currently approved CCERs within six years
of the rule’s effective date. Concerns were raised about the ability of manufacturers to supply
newly approved products in sufficient quantity to replace all currently deployed CCERs within
the proposed six-year period. The Federal agencies with workplace safety regulatory authority
(e.g., MSHA) govern the use of respirators in workplaces and would be in a superior position after
implementation of this rule to consider product availability in allowing or curtailing the continued
use of currently deployed CCERs.
RECOMMENDATION
I recommend that you sign the attached Final Rule: Approval Tests and Standards for ClosedCircuit Escape Respirators (42 CFR 84).
Thomas R. Frieden, MD, MPH
Attachment:
Approval Tests and Standards for Closed-Circuit Escape Respirators (42 CFR 84) Final Rule
Decision:
Approved: _______
No: _______
Would like to be briefed before signing: ___________________
Other/Comments:
_________________________
Kathleen Sebelius
Secretary
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APPENDIX G: T HE EXECUTIVE SECRETARIAT CLEARANCE PROCESS
Any correspondence requiring the signature of the Director or Deputy Directors, CDC; the Assistant
Secretary for Health and Surgeon General, HHS; the Deputy Secretary, HHS; the Secretary, HHS;
or the President of the United States must be reviewed and cleared by CDC’s Division of Executive
Secretariat.
When CIOs draft response letters or memoranda that have to be signed by any of these people, the
drafts must be sent back to the Division of Executive Secretariat within the following time frames:
• Director’s signature
5 days
• Deputy Director’s signature 5 days
• Secretary’s signature
3 days
If CIOs are asked to reply to the senders directly, they have 5 working days to respond. CIOs are
responsible for obtaining the proper signature(s), dating the response, and mailing the document.
CIOs should then forward a copy of the signed, dated, final copy to the Division of Executive
Secretariat so that the file can be closed.
Also, when CIOs initiate letters or memoranda that have to be signed by the above-mentioned people,
these documents must be submitted in draft form (i.e., double-spaced) to the appropriate Executive
Secretariat contact person for clearance and processing. To find your CIO’s contact person, visit
http://intranet.cdc.gov/od/ocs/resources.htm or call (404) 639-7120. The draft must contain the
proper approvals at the CIO OD level.
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GLOSSARY OF TERMS
Acronym. Word formed from the initial letters
of a series of words, such as CDC. Acronyms
do not have periods between the letters.
Expletive. Word or phrase that brings no
meaning to the sentence (i.e., there is, there are,
and it is). Avoid using expletives.
Active Voice. See Voice.
Font. Complete set of letters, numbers, and
symbols available in one type or typeface.
See also Typeface.
Alignment. See Justification.
Attachment. Additional material attached to a
memo.
Audience. Person(s) who will read the
document. Audience can be specialized and
have considerable knowledge of the topic,
generalized and have little or no knowledge
of the topic, or a combination. Knowing the
audience can help the writer craft a useful,
understandable message.
Body. Main block of text in a document, as
opposed to titles, addresses, and signatures.
Bullet. Small marker generally used instead
of numbers to create lists. Bullets separate
material into easily understandable chunks.
• This is a typical bullet.
Contraction. Word formed by combining two
words and using an apostrophe, such as we’ll.
Because contractions are informal, they should
not be used in correspondence.
Dash. Punctuation mark. There are two types of
dashes: the en dash (–) and the em dash (—).
An en dash indicates ranges (e.g., 1990–1995,
10%–20%). An em dash indicates a break in
thought or sentence structure (e.g., He came
to the meeting— for the first time ever—and
spoke up). See also Hyphen.
Enclosure. Additional material enclosed with
a letter.
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Function Keys. Keys named F1 through F12
located on the top row of the keyboard.
Function keys activate specific computer
commands, and may also be referred to as
F keys.
Header. Identifying information at the top of
each page in a document. The first page usually
does not have a header.
Hyphen. Punctuation mark (-) used between
the parts of a compound word or name (e.g.,
high-fiber diet, Myers-Briggs type indicator).
See also Dash.
Jargon. Technical language of a specialized
group. Avoid jargon.
Justification. Text alignment on the page. Fully
justified text is aligned at both the left and
right margins. Text that is justified left or right
means that the text is aligned at the left-hand
or right-hand margin. A margin that is justified
on the left side only is also called a ragged right
margin.
Layout. Manner in which all the elements that
make up a document are placed on a page. An
effective layout guides the reader’s eyes through
the page smoothly, increasing readability and
retention.
Letter. Formal correspondence sent outside CDC.
Memorandum/Memo. Brief communication
that contains directive, advisory, or
informative matter and that is distributed
within CDC or sent to HHS. The plural is
memorandums or memoranda.
Nominalization. Use of nouns instead of
verbs (e.g., the document includes a list of
all projects, instead of “the document lists all
projects”). Avoid nominalizations.
Page Formatting. Elements affecting the look of
the page, such as headers, margin size, and line
spacing.
Typeface. Family of individual fonts. “Times
New Roman” and “Arial” are the two standard
typefaces used at CDC.
Voice. Attribute of a verb that indicates whether
the subject is active (Mr. Marsh wrote the
letter) or passive (the letter was written by
Mr. Marsh).
Watermark. Text or graphic that appears greyedout in the background of a document.
Paragraph. Sentence or group of sentences
treating a single topic. Paragraphs are separated
by blank lines and are not indented.
Passive Voice. See Voice.
Plain Language. Way of writing that is
clear and simple because the document is
visually appealing, organized logically, and
understandable the first time it is read. The
Plain Writing Act of 2010 requires that federal
agencies communicate clearly.
Style. Way a document is written. Style is a
combination of characteristics such as the
choice and arrangement of words and ideas.
Tone. Manner of expression that reflects the
writer’s attitude toward the reader. The tone of
a letter should always be courteous, respectful,
and polite.
Toolbar. Row of buttons and icons at the top of
the Word or Outlook screen. The toolbar lets
you access frequently-used commands.
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BIBLIOGRAPHY
Reference Manuals
American Medical Association Manual of Style. 10th Edition. Oxford: Oxford University Press, 2007.
The AMA is CDC’s preferred reference for scientific writing. Online at www.amamanualofstyle.com.
Merriam-Webster’s Collegiate Dictionary. 11th Edition. Springfield, Mass: Merriam-Webster, Inc., 2008.
CDC’s preferred dictionary. Abridged version available online at www.merriam-webster.com.
Sabin WA. The Gregg Reference Manual. 11th ed. New York (NY): McGraw-Hill; 2011.
This manual is the standard guide for correspondence rules.
Strunk M, White EB. The Elements of Style. 4th ed. New York (NY): Longman; 2000.
This essential classic reference book is also available at www.bartleby.com/141/.
The Chicago Manual of Style. 16th Edition. Chicago: University of Chicago Press, 2010.
CMOS is CDC’s preferred reference for non-technical writing. Online at www.chicagomanualofstyle.org/.
The U.S. Government Style Manual. 30th ed. Washington, DC: United States Government Printing Office;
2008. www.gpoaccess.gov/stylemanual/browse.html.
Although it differs at times from CDC style, the federal style guide is another helpful resource.
Useful Websites
www.plainlanguage.gov
Link to most recent federal plain language guidelines and other resources to help you improve your writing.
http://brandidentitystandards.cdc.gov/
Learn about CDC’s brand and identity.
http://intranet.cdc.gov/cdcweb/usability/508/
Learn about Section 508 compliance for the Web.
www.yourdictionary.com
Check spelling and definitions.
http://oxforddictionaries.com/page/betterwriting_us/better-writing
Address questions pertaining to language, grammar, writing, and more.
www.chicagomanualofstyle.org
Use CDC’s preferred reference for non-technical writing.
http://wsuonline.weber.edu/wrh/words.htm
Learn the difference between words that are often confused (e.g., critique/criticize, who/whom).
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